SECTION 1 – Volunteer/Student Information
Name:
Address:
City:	State:	Zip:
Phone:	Email:
Emergency Contact Name:
Relationship:	Parent	Spouse	Brother/Sister	Other
Address:
City:	State:	Zip:
Phone:	Email:
SECTION 2 – Volunteer Agreement
I understand that I am a volunteer for the Virginia Department of Forestry and will receive no financial compensation or benefits for assistance rendered in any capacity to the Department. I am aware that the volunteer activities pose significant risk of bodily harm to myself, including permanent paralysis and death. I am aware that such injuries may occur despite all reasonable precautions by myself and the Department of Forestry, its employees and/or agents, and such injuries are an acknowledged, if rare, hazard associated with volunteer activities, especially those performed in forests or involving tools and power equipment. I have been fully advised of these potential dangers and I knowingly and freely assume all such risks. If I am injured while performing volunteer duties, medical claims are my responsibility (personal insurance or cash payment). In the event of such an injury, my insurer or I may file a claim for reimbursement of such expenses with the Department of Forestry, which will forward the claim to the Virginia Division of Risk Management. The Division of Risk Management will evaluate the request for reimbursement in accordance with the laws and regulations governing such requests. I understand that filing a claim for reimbursement does not guarantee acceptance of the claim or reimbursement of any expenses.
Volunteer/Student Signature	Date
Is Volunteer/Student Under Age 18?	Yes	No
Parent/Guardian Signature is required if Volunteer/Student is under age 18:
Parent/Guardian Name	Parent/Guardian Signature	Date
SECTION 3 – Volunteer/Student Assignment
Description of Volunteer/Student Assignment:
SECTION 4 – VDOF Approval
VDOF Employee Name	VDOF Employee Signature	Date