Unit Name-Sport/Department:	Athletics &Physical Education-
University Volunteer Name (Print):
University Volunteer Title:
University Volunteer Duty 1:
University Volunteer Duty 2:
Other Duties:
Specialized Skills Expected from individual mentioned above:
Notes:

EMERGENCY CONTACT (This individual will only be contacted if you have a medical or other emergency)
Last Name:
First Name:
Relationship:
Telephone #

University Volunteer Signature:
Date:

Please provide references (the first must be your most current supervisor) per University Policy.

Name	Contact Information	Relationship	Date Contacted (dept use only)
1)
Most recent supervisor
2)
3)

I will be providing University oversight and attest that I have contacted the references listed above on the date specified: (name of dept staff member) _________________________________________

We are pleased that you have decided to volunteer your services to Cornell University and the Department of Athletics and Physical Education (hereinafter referred to as “Cornell”).

Please affirm your acceptance of the terms of this agreement, stated below, with your signature. Also, please accept our sincere thanks for your valuable contribution to Cornell University.

I agree that as university volunteer my participation in the activities outlines in the attached Cornell University Description of Volunteer Duties is without valuable consideration. That Document shall be considered a part of this agreement.

I understand that the university shall have the right to release me as university volunteer without prior notice. I understand that I do not have a formal work appointment for those particular services.

I understand that as a university volunteer Cornell does not provide me with accident or medical insurance, and is therefore not responsible for any accident or medical expenses incurred by me. Further, I understand that I am neither covered by Workers’ Compensation nor entitled to employee benefits as a result of my university volunteer affiliation.

Cornell agreed to provide me with a third party liability insurance to protect me from any claims files against me related to the duties described in the attached Cornell University Description of Volunteer Duties. In exchange, I, on behalf of myself, my heirs, and my representatives do hereby release, indemnify, and hold harmless Cornell or any of its officers, agents, or employees from any and all liability, damage, or claim of any nature that arises out of or related to my volunteer activities.

I am aware of the terms and conditions of this agreement and am signing this agreement of my own free will. Further, by signing this agreement I attest to the fact that I am eighteen years of age or older.

This agreement is valid from ___________ to __________ (not past 06/30 of the current Fiscal Year).

University Volunteers Signature and Date: ________________________________________________

Address:
City:
State:
Zip:

For reporting purposes only.

Race

(Optional):	__	Caucasian	Ethnicity:	__	Hispanic/Latino
__	African American	(Optional)	__	Not Hispanic/Latino
__	Asian
__	American Indian / Alaskan Native
__	Native Hawaiian/ Other Pacific Islander
Provide one copy of this agreement to the university volunteer and original to Athletics/PE Human Resources.

This agreement will be retained for three years from university volunteer separation.

CORNELL UNIVERSITY VOLUNTEER AGREEMENT

CORNELL UNIVERSITY DESCRIPTION of

VOLUNTEER SERVICE

Unit Name-Sport/Department:

José Delgado

2013-10-29

Ron Babuka

Cornell University