Form Center

2. Adopt a Park is a public service program for volunteers to assist the City in keeping parks beautiful.
   Park Ambassadors are responsible for reviewing the Park Ambassador Checklist once a month and reporting any areas of improvement. Adopt a Park is open to community groups, businesses, churches and individual citizens. Those choosing to participate in the Adopt a Park Program will have a sign located in the area indicating their adoption of the park. Urbandale Parks & Recreation will be in contact if an initial on-site meeting is required to go over maintenance needs and frequency requirements.
4. Park Ambassador will be responsible for:
   Completing the Park Ambassador Checklist at least once a month. The checklist includes: pick up litter within entire adoption area a minimum of twice a month. Trash bags are available at the Parks and Recreation office at no charge. Please put bags in trash receptacles where possible. Notify staff if garbage is full. Remove any broken glass, limbs, etc. No power equipment is to be used. Large work will be done by City Staff. Please call Urbandale Parks and Recreation at 278-3963. Inspect signs, playground equipment, picnic tables, open shelters, restrooms and report vandalism or concerns/repairs as needed to Urbandale Parks and Recreation at 278-3963.
6. It is the intent of this agreement to provide quality, attractive parks to enhance the beauty of our city. Park staff will periodically check your adopted area throughout your adoption period. If, at any time, you need assistance or problems meeting the maintenance schedule, please call the Park and Recreation office for support at 278-3963.
8. Thank you for volunteering your time and effort! Urbandale is a great community because of you!
12. Adoption Area Information
14. Adoption Park*
16. Adoption Period*
    Adoption Period Start Date

    —

    Adoption Period End Date
    Minimum 1 year
18. I/We hereby proudly agree to maintain the adopted area for the specified time frame.
    Volunteer acknowledges that they are volunteers and are in no way considered to be employees of the City of Urbandale. Volunteer will not hold the City of Urbandale or its appointed staff responsible in case of accident/injury or loss as a result of participation in the Adopt a Park Program. Please find the Participant Waiver, below.
20. Signature of Park Ambassador*
22. Wording on Sign*
    Those choosing to participate in the Adopt a Park Program will have a sign located in the area indicating their adoption of the park.
24. Address*
26. Email Address*
28. Phone Number*
30. Shirt Size*
    -- Select One --SmallMediumLargeX Large

    Adult Sizes
34. City of Urbandale Volunteer Waiver
    In consideration of me, or my minor child, being permitted to participate in any way in the Parks Ambassador Program, I, the Undertyped, for myself and my minor child, all of my or my minor child's, personal representatives, executors, administrators, heirs, next of kin, successors and assigns, herein referred to as "Releasors", do hereby: 1. Acknowledge that this volunteer service carries with it the potential for serious injury, death and/or property damage, and certify as to my physical fitness and that of my minor child to participate and declare that neither I, nor my minor child, have been advised otherwise by a qualified medical professional. 2. Acknowledge, agree, and represent that I and my minor child will, at all times, be aware of the surroundings during the volunteer service and agree that if I or my minor child consider anything related to this Activity to be unsafe, will immediately advise the Activity officials of such, and if necessary, will leave the area or refuse to participate further in the volunteer service. 3. Waive, release and discharge, and covenant not to sue, the City of Urbandale, Iowa, its elected and appointed officials, employees, volunteers, sponsors, and agents, including others who give recommendations, directions, or instructions as part of this volunteer service, hereinafter referred to as "City", from any and all liability to Releasors, except for my minor child, for any and all loss or damage, and any claim or demands therefor, on account of injury to the person or property or resulting in my death or that of my minor child arising out of or related to the volunteer service, including traveling to or from the volunteer service. 4. Agree to Indemnify and Save and Hold Harmless the City and each of them from any loss, liability, damage, or cost that they may incur arising out of or related to me or my minor child's participation in this volunteer service. 5. Assume full responsibility for any risk of bodily injury, death or property damage arising out of or related to the volunteer service. 6. Agree that this Release and Waiver of Liability and Assumption of Risk Agreement and Photo Release extends to all acts of negligence by the City, not including gross negligence and willful misconduct, and is intended to be as broad and inclusive as is permitted by law including any governmental immunity afforded the City by law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. 7. Authorize any medical treatment, including the administration of anesthesia, deemed advisable by any licensed physician to relieve any injuries received or illness contracted by me or my minor child as a participant in this volunteer service. I hereby agree to pay all costs of any medical treatment or emergency transportation. 8. Authorize and consent to the City, its sponsors, and any news media, and their successors and assigns and those acting under their authority, to take, publish, use in any media, and copyright photographs, videotape or other and audio or visual media, including broadcast in any media, of me or my minor child and agree that such may be used for any lawful purpose without further compensation or approval. I have read this Release and Waiver and Assumption of Risk Agreement and Photo Release, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it voluntarily without assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the fullest extent permitted by law, including all acts of negligence by the City as stated above.
36. Signature of Park Ambassador*
38. Date*
    Date
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field