Guide/Support Form

2019 Jamboree Guide Sign Up
Please fill out the information below if you would like to serve as a guide or support rider for the 2019 Rocky Mountain Jamboree. Please note that you must maintain at least part year residency in a County that has access to the Paiute Trail in order to serve as a guide or support rider.
Name:

Previously Used Names (Maiden Name)

Date of Birth*

Gender

 Male   Female

Address:

Address Line 2:

City or Town:

State or Province:

Zip or Postal Code:

Work Phone:

Cell Phone:

Email Address

Age*

 18 and Over   Under 18

Reason for Volunteering
 Personal Interest   Community Service

If you will be driving while performing volunteer service, please complete the following.
Is your Driver's License Current and Valid?*
 Yes
 No

Drivers License Number*

What is your full name as it appears on your Driver's License*

Have you completed a Defensive Driving Course in the past five years?
 Yes
 No

Do you currently have the minimum vehicle insurance coverage as required by the State of Utah ?
 Yes
 No

I understand that either the County or I may cancel this agreement at any time by notifying the other party.*
 Yes
 No

I certify that the facts set forth in this volunteer application are true and complete to the best of my knowledge. I understand that any false statement, omission or misrepresentation constitutes cause for the rejection of my application or discharge from the volunteer program, regardless of the time of discovery.*
 Yes
 No

I understand that, if I am injured or involved in an accident while providing volunteer services to the County, the County’s worker’s compensation carrier will only pay the actual and necessary medical expenses I incur in the treatment of an injury. Other expenses such as lost work time, equipment, clothing, etc. will not be covered by worker’s compensation insurance.*
 Yes
 No

I understand I may be subject to a criminal record check or other background investigation.*
 Yes
 No

I hereby volunteer my services to assist Sevier County in the authorized work upon the terms and conditions above.*
 Yes
 No

Thanks for your willingness to help with the 2019 Jamboree.

     
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