Heart
of Illinois Senior Olympics – Volunteer Committee 
VOLUNTEER REGISTRATION FORM
The Volunteer Committee for the Heart of Illinois
Senior Olympics is seeking volunteers 14 years of age and older to assist in
conducting the Heart of Illinois Senior Olympics 2009. All volunteer registration forms MUST
be returned to HISO by Friday, April 3rd, 2009.
Review
the schedule of events to see where you
would like to help. Check the days,
times you have available.
The Heart of Illinois Senior Olympics 2009 Games will be held Thursday April 30 through Sunday, May 3 in several Peoria, East Peoria, Pekin and Morton locations. HISO is a friendly competition and social event for men and women 50 years and older.
There will be a Volunteer Orientation Meeting
Date and Time to be determined.
HISO Volunteer T-shirts and Name Tags will be distributed at this time, so be sure to mark your calendar for this important date. Refreshments will be provided.
Fill
in all information requested in spaces below.
(Please type or print in ink)
Name_______________________________________________________
Age ________________________
Address________________________________________________________________________
City, State, Zip
Code______________________________________________________________
Day
Phone________________________ Evening Phone____________________ Shirt Size____
E-Mail_________________________________________
Fax _____________________________
Liability waiver and Release of All
Claims
As a volunteer for the Heart of Illinois Senior Olympics or the parent/guardian of a volunteer, I recognize and acknowledge there are certain risk of physical injury and I agree to assume full responsibility for any injuries including death, damages or loss which I or my minor child/ward may sustain as a result of participating as a volunteer. I do hereby fully release and discharge the Heart of Illinois Senior Olympics, Fondulac Park District, Morton Park District, Pekin Park District, and their sponsors, officers, agents, servants and employees from any and all claims from injuries, including death, damages or loss which I or my minor child/ward may have or which may accrue to me on account of participation as a volunteer for the Heart of Illinois Senior Olympics. In the event of any emergency, I authorize heart of Illinois Senior Olympics officials to secure from any licensed hospital, physician, and/or medical personnel or good Samaritan first aid providers, and treatment deemed necessary for my immediate care and agree that I will be responsible for payment of any and all medical services rendered. In addition, I hereby consent to the use of my photograph in Heart of Illinois Senior Olympics brochures, publications, slide presentations, etc.
I have read and fully understand the above details of the Heart of Illinois Senior Olympics Liability Waiver and Release of All Claims and permission to secure medical treatment.
_____________________________________________________________
Signature of Participant or Parent/Guardian Date
Return both this form and the schedule to:
Brian Barry, Manager of Volunteers
HISO – Peoria Park District
2218 N Prospect Road
Peoria, IL, 61603