Volunteer Application

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Coral Molly O’Neal’
5 years ago
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Memorial and Museum 62 Battleship Place Camden, New Jersey 08103 Volunteer Application Name: Address:.

1 Memorial and Museum 62 Battleship Place Camden, New Jersey Volunteer Application Name: Address:. Telephone: Home ( ) Cell ( ) Area(s) of Interest: Referred by: Please complete the attached forms and return to: Office of Volunteer Affairs 62 Battleship Place Camden, NJ Telephone: (856) Ext m.chase@battleshipnewjersey.org

2 6 2 B a t t l e s h i p P l a c e C a m d e n W a t e r f r o n t C a m d e n N e w J e r s e y M a i n : F a x : Release and Waiver of Liability, Assumption of Risks and Indemnity Agreement In consideration of being permitted to enter for any purpose any area of the Battleship New Jersey (the VESSEL, herein defined as any interior or exterior area of the Battleship New Jersey or facilities or areas ancillary or adjacent thereto) THE UNDERSIGNED, for him/herself personal representatives, heir and next of kin: 1. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the Battleship New Jersey, a non-profit corporation (HPA), any persons on the VESSEL, contractors, workers, staff, owners and lessees of areas adjacent to the VESSEL, owners and lessees of equipment, consultants, and others who give recommendations, directions or instructions or engage in risk evaluations or loss control activities regarding the VESSEL and/or areas adjacent thereto, equipment of Battleship activities and each of them, their trustees, directors, officers, agents and employees, all for the purposes herein referred to as RELEASEES, FROM ALL LIABILITY THE UNDERSIGNED, his/her personal DEMANDS THEREFORE ON ACCOUNT OF INJURY TO PERSON OR PROPERTY OR RESULTING IN EQUIPMENT OR BATTLESHIP ACTIVITIES WHETHER CAUSES BY THE NEGLIGENCE OF THE RELEASES OR OTHERWISE. 2. HEREBY AGREES TO INDEMNITY AND SAVE AND HOLD HARMLESS the RELEASEES and each of them FROM ANY LOSS, LIABILITY, DAMAGE OR COST they may incur arising out of or related to the VESSEL and/or ADJACENT AREAS, or EQUIPMENT WHETHER CAUSED THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. 3. HEREBY ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE arising out of or related to the VESSEL and/or ADJACENT AREAS, EQUIPMENT or whether caused by the NEGLIGENCE OF THE RELEASEES OR OTHERWISE. 4. Acknowledges, agrees, and represents that (s) he has or will immediately upon entering the VESSEL and/or ADJACENT AREAS, and will continuously thereafter, inspect the VESSEL and/or ADJACENT AREAS which (s) he enters and (s) he further agrees and warrants that, if at any time, (s) he is in or about the VESSEL and/or ADJACENT AREAS and (s) he feels anything to be unsafe, (s) he will immediately advise Battleship personnel of such and will leave the VESSEL and/or such ADJACENT AREAS. 5. HEREBY acknowledges that the VESSEL and adjacent areas have not been prepared for the public, are in the process of rehabilitation and construction, and that access to the VESSEL and/or ADJACENT AREAS involves the risk of serious injury and/or death and/or property damage. THE UNDERSIGNED also expressly acknowledges that INJURY RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.

3 6. HEREBY acknowledges that Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by the RELEASEES, INCLUDING NEGLIGENT RESCUE OPERATIONS, and is intended to be as broad and inclusive as is permitted by the laws of the State of New Jersey, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME, AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. PRINT NAME HERE SIGN NAME HERE DATE Volunteers Waiver 11/17

6 2 B a t t l e s h i p P l a c e C a m d e n W a t e r f r o n t C a m d e n N e w J e r s e y 0 8 1 0 3 M a i n : 8 5 6-9 6 6-1652 F a x : 8 5 6-583- 0103 EMERGENCY CONTACT SHEET FULL NAME: HOME

4 6 2 B a t t l e s h i p P l a c e C a m d e n W a t e r f r o n t C a m d e n N e w J e r s e y M a i n : F a x : EMERGENCY CONTACT SHEET FULL NAME: HOME ADDRESS: HOME PHONE: CELL PHONE: DATE OF BIRTH: L ADDRESS: EMERGENCY CONTACT NAME: EMER. CONTACT RELATION TO YOU: SPOUSE RELATIVE OTHER: EMER. CONTACT ADDRESS: EMER. CONTACT PHONE: IS THIS A CELL? YES NO VOL_EMERGENCY_CONTACT_11/17

5 STATE OF NEW JERSEY DEPARTMENT OF LAW AND PUBLIC SAFETY DIVISION OF ALCOHOLIC BEVERAGE CONTROL P.O BOX 087, TRENTON, NJ (609) THIS FORM MUST BE FULLY COMPLETED AND KEPT ON LICENSED PREMISES AND AVAILABLE FOR INSPECTION PERSONS EMPLOYED OF RETAIL LICENSED PREMISES BY: NAME OF LICENSEE ADDRESS MUNICIPALITY 12 DIGIT LICENSE NUMBER Volunteers: Name Address of Actual Residence Age Place and Date of Birth U.S. Citizen YES NO Position Starting Date Convicted of Crime YES NO Sell, Serve or Deliver Acl. Bev YES NO ABC Employment Permit No. (if Held)

ALL DRIVERS MUST COMPLETE INFORMATION BELOW

ALL DRIVERS MUST COMPLETE INFORMATION BELOW Mailing Address: PO Box 322 Lancaster, NY 14086 Phone: 716-759-6818 Website: LancasterNationalSpeedway.com 2018 STOCK CAR REGISTRATION, MEMBERSHIP & NUMBER APPLICATION PLEASE PRINT LEGIBLY ALL DRIVERS