Persons interested in serving as contractual soccer referees should complete this form. 

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* 1. Contact Information

I, the undersigned, intend to volunteer my services in the Department of Recreation and Parks for the City of Hopewell. I am not an employee of the City of Hopewell and will not receive any compensation or benefits for my services. I understand that in my volunteer activity there is a risk for injury, illness, damage, and loss inherent in the above selected activity categories. Understanding the risk, I agree to assume all risk associated with my services. I voluntarily consent to and authorize the City of Hopewell to obtain my criminal history record from any appropriate source, including the Virginia Criminal Records Exchange, any bonafide third-party service provider, or the records of the City of Hopewell. The Director of Recreation and Parks is hereby authorized to obtain and disseminate such criminal history record to his/her designee or other relevant City officials and/or representatives. I agree to release the City and its representatives from any and all claims, liability, and responsibility arising out of the release of such information in connection with this research. In consideration of the opportunity to volunteer, I hereby release and forever discharge the City of Hopewell, its Council, Officers, and employees, from any and all claims, costs, liabilities, expenses, and judgements whatsoever, including attorney's fees and court costs, arising out of my performance of service, to the extent allowed by law. If any portion of the Waiver of Release is ruled invalid or void by a court of competent jurisdiction, the remainder shall be effective to the extent permitted by law. This Release shall continue in effect indefinitely unless terminated or modified with the written consent of the City Manager.  By clicking "I Accept" below, I confirm my understanding that any electronic signatures appearing on this application or such other documents are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.

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* 2. To electronically sign this application, please check the "I Accept" button listed below.

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