Text Size
 

 
 
 

New Connect Volunteer Application

Applicant information

Current address and contact information

Driver's license information (for background check)

Volunteer waiver

I, for myself and all of my representatives, agree to hold the City of Brooklyn Park (“City”) harmless from all liability that may occur during my time volunteering with the New Connect Program.

I understand that there may be risk involved with my volunteering. I assume those risks, and I waive all liability and any right to make any claims or pursue any lawsuits against the City, its directors, officers, employees, volunteers, representatives, and agents for any injuries or damages, regardless of their cause, which may occur while performing this volunteer work.

In addition, I assume any and all risks for any injuries or damages, regardless of their cause, which may occur to anyone who may accompany me while I am performing these volunteer duties. My participation in this activity is voluntary. I agree to serve as a volunteer and commit to the following:

  1. To perform my duties to the best of my ability.
  2. To adhere to city rules and procedures, including legal responsibility for the consequences of my actions while on duty.
  3. To only represent the City of Brooklyn Park, and no other organization while on duty.

Photo and video release waiver

I give the City of Brooklyn Park, its representatives and employees, (collectively “City”) permission to take photographs and videos of me and to use, reproduce or publish photographs or videos of my image, likeness and voice, without compensation, for the City’s educational and other programs or projects. I understand that my likeness may be used in City publications, literature, the internet, or any other means that the City may choose. I grant permission to the City to edit or retouch such images, and I waive any right to inspect or approve the images now or in the future.

I agree that the City may use such photographs or videos of me with or without my name and for any lawful purpose, including such purposes as publicity, illustration, advertising, and web content.

I fully release the City, and waive any claim against the City, for damages of any kind arising out of the use or the publication of images of me by the City. I agree not to sue or otherwise initiate legal proceedings against the City for use or publication as described above.

Tennessen Warning

Information requested on your application is private and may be released only to you (MS13.04 Subd 2). Private data contained include:

  • Name: You must provide your name. This is used to identify you from other applicants.  Also used in background check.  Failure to provide this may result in a delay in processing or rejection of application
  • Location of employment: Needed to determine eligibility.  If you live in Brooklyn Park, employment information is not needed.  If you do not live in Brooklyn Park but work in the city, you are eligible for this program.  Failure to provide this information may result in a delay in processing or rejection of the application. 
  • Local/permanent address/home telephone: Used to contact you regarding your application’s status.  You are not required to provide this information.  Failure to provide this information may result in a delay of processing or notifying you of your applicant’s status.
  • License Information: Used for background check.  You are required to provide this information. Failure to provide this information may result in your rejection as an applicant.
  • Date of Birth: Used for background investigation and to check minimum age requirements for the program Failure to provide this information may result in rejection of your application.

Agreement

I agree that all answers to the above questions are true and I agree and understand that any false statements contained in this application may cause rejection of this application. I am aware that the above information will be used in obtaining a criminal history.

I have read and understand the Volunteer Waiver and the Photo and Video Release Waiver. I am confirming this release knowingly and voluntarily.

 
close (X)