Volunteer's Release/Appointment Form

To be completed by the Account Manager (For the area in which volunteer provides services): 

Volunteer's Name:

____________________________

_______

________________________________

                         (first)

   (m.i.)

                           (last)

Acct. # & Dept. Name:

CC/FC_____________________________

____________________________________________________________________________

 

(account number)

(department name)

 

 

 

Effective Dates:

Start _________ - _____ - __________

End __________ - _____ - __________

           (month)      (day)          (year)

          (month)        (day)          (year)

 

 

 

 

 

 

Hours Per Week:

__________

Job Duties :

___________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

Supervisor:

Name ____________________________________________

Telephone Number ___________________________

 

 

 

 

 

 

Releases:

The Board of Regents, Texas State University System, Texas State University-San Marcos (Texas State), the supervisor named above, and all employees and agents of Texas State, acting officially or otherwise.

Volunteerís Statement:

Services:

 

During the time specified, I will be performing volunteer services described above for Texas State.

 

 

 

Volunteer Status:

 

During this period I will not be an employee or agent of Texas State and will not be paid for my services or be eligible for employee benefits, including workers' compensation benefits.

 

 

 

Release:

 

In consideration for Texas State providing me this opportunity, I (for myself, my heirs, executors, and administrators) release, discharge, and agree not to sue the Releases named above for any claim that I may have arising from my volunteer status. This release includes claims for injuries to me (including my death) and damage to my property that may occur from any cause during the period of my service.

 

 

 

Employment Status:

 

I certify that I am (check one):

 

 

____Not employed by the State of Texas, Texas State University-San Marcos, or the Texas State University System.  I am performing the proposed volunteer service for charitable, civic or humanitarian reasons.

____An employee of the State of Texas, Texas State University-San Marcos or the Texas State University System. The proposed volunteer service is in a different occupational capacity from that in which I am employed, and I am performing the volunteer service for civic, charitable or humanitarian reasons. My employment at Texas State is as follows:             

††††††††††† Account Manager:__________________________________________

            Job title:   ________________________________________________

 

 

 

 

 

 

 

 

 

Free Act:

 

I have read this release and understand it. I sign it voluntarily as my own free act. No person has made any additional representations to induce me to sign this agreement. I execute this agreement having received full and adequate consideration for it, intending to be bound by it and by Texas law.

 

__________________________________________________________

 

___________________

 

Volunteer's Signature

 

Date

 

 

__________________________________________________________

 

___________________

 

Account Managerís Signature*

 

Date

 

 

 

 

 

 

 

 

 

*The account manager must keep a copy of the signed release on file for two years after the last date of service.