Phone     Alternate Phone

Do you have any medical conditions that would interfere with your ability to volunteer?
Please specify

I certify that the information given on this form is true and correct to the best of my knowledge and
belief and is made in good faith. Any false statements made by me on this form may result in refusal of or separation from volunteer service upon discovery thereof. Additionally, I understand that during the recruitment process, this organization may contact the references I listed. Finally, submission of this application is not a guarantee of acceptance or placement into the Cylburn Arboretum Association’s volunteer program. Applicants will be contacted and interviewed for positions available.

Disclaimers and Consent

Cylburn Arboretum Association
4915 Greenspring Avenue
Baltimore, MD 21209 = 410.367.2217

Read Carefully Before Signing:
I hereby consent to permit Cylburn Arboretum Association to contact anyone it deems appropriate
to investigate or verify any information provided by me to discuss my suitability for a volunteer position, including my background, volunteer experience, education, or related matters. I expressly give my consent to any discussions regarding the foregoing, and I voluntarily and knowingly waive all rights to bring an action for defamation, invasion of privacy, or similar cause of action, against anyone providing such information.

I hereby consent to permit Cylburn Arboretum Association to contact anyone it deems appropriate
to investigate or verify any information provided by me to discuss my suitability for a volunteer position, including my background, volunteer experience, education, or related matters.
I expressly give my consent to any discussions regarding the foregoing, and I voluntarily and knowingly waive all rights to bring an action for defamation, invasion of privacy, or similar cause of action, against anyone providing such information.

I hereby authorize any organization affiliated with Cylburn Arboretum Association to responsible and liable for medical treatment and all related costs in the event of an injury to myself as a result of
my participation in volunteer activities at Cylburn.

I certify that the answers given by me on all forms are, to the best of my knowledge and belief,
true and correct and that I have not knowingly withheld any pertinent facts or circumstances.
I understand that any omission or misrepresentation of fact on any forms may result in refusal
of or separation from volunteer service upon discovery thereof.

If, during my participation in Cylburn Arboretum activities, I should need emergency medical treatment, and I am not able to give my consent or make my own arrangements for that treatment because of my injuries, I authorize Cylburn Arboretum Association to take whatever measures are necessary to protect my health and well-being, including, if necessary, hospitalization.

I hereby acknowledge and assume the risk of participating in volunteer activities at Cylburn,
a city park and arboretum. I understand there are inherent risks involved with volunteer activities,
which may include but not limited to exposure to varying weather conditions, harmful plants,
insects, and wildlife. I hereby acknowledge my understanding and acceptance of these risks
and hereby indemnify, release, and hold harmless the Cylburn Arboretum Association,
its Board of Directors, officers, employees, volunteers, advisors, representatives,
and the Division of Horticulture from any claims for injury, damage, or loss to person or property that may result from my volunteer participation at Cylburn.

I hereby further acknowledge and understand that the Cylburn Arboretum Association
does not offer any health or medical insurance to volunteers and that I am encouraged
to have my own health/accidental insurance coverage. I also understand and agree that
I am personally responsible and liable for medical treatment and all related costs in the
event of an injury to myself as a result of my participation in volunteer activities at Cylburn.

I certify that the answers given by me on all forms are, to the best of my knowledge and belief,
true and correct and that I have not knowingly withheld any pertinent facts or circumstances.
I understand that any omission or misrepresentation of fact on any forms may result in refusal
of or separation from volunteer service upon discovery thereof.