Thank you for applying to be a Dog Park Ambassador for the City of Des Moines Parks and Recreation Department. We strive to provide a safe and fun environment for people and their pets to recreate.
Please fill out the application, disclosure, waiver of liability and assumption of risk agreement, and our photo release. Once the information is complete, you will be sent a set of background check links (organization pays or you can donate and self-pay which can also speed up the process). As part of the two-step background check process, Background Investigation Bureau (BIB) will also send you some State of Iowa paperwork via their SignNow system. That information will go directly back to BIB.
Once you pass your background check with BIB and your application with us is approved, we will be able to do a short interview/orientation.
COVID-19:
In order to comply with emergency proclamations by the Governor or Mayor, as such may be amended from time to time, and as public health guidelines evolve, for the safety of staff and the public, the Parks and Recreation Department reserves the right to cancel at any time. In addition, the Department reserves the right to change the registration requirements at any time. The Department will contact the volunteers as soon as reasonably possible with such cancellation or changes.
The City of Des Moines cannot guarantee that the volunteer or any of the event attendees will not become infected with COVID-19. Volunteers and attendees use the City’s facility at their own risk.
Required fields are marked with an asterisk (*). First Name *
Last Name *
Cell Phone *
For example, 123-456-7890
Other Phone
Address *
City *
Zip Code *
Employer/Organization
Date of Birth *
T-shirt Size: *
Emergency Contact Name *
Emergency Contact Phone *
I am interested in being an Ambassador at: *
Will you be volunteering with your dogs?
Dog names?
Dog Park permit number?
Please list any past experience you have working with the dogs or the public:
Other Interests/Knowledge/Skills/Abilities
VOLUNTEER APPLICATION STATEMENT
I understand that as a volunteer with the City of Des Moines Parks and Recreation Department the knowledge I gain regarding the performance, behavior, and personal information of the Vulnerable Populations (children, elderly persons, and persons with disabilities), staff, and citizens with whom I work is confidential and I agree to respect such confidentiality.
I understand that if a child tells me something or I notice something that may indicate his/her safety is at risk or he/she is in emotional distress, I will report that information to the appropriate staff member as soon as possible.
I understand that any contact with children, volunteers, or staff beyond the boundaries of the specific volunteer activity is discouraged, is not a part of City of Des Moines Parks and Recreation programming, and will not be protected in terms of liability. This includes communication with social media.
I understand that the City of Des Moines Parks and Recreation does not discriminate on the basis of race, color, national origin, gender, disability, religion, creed, age, familial status, sexual orientation, gender identity, and ancestry in its programs and its employment practices.
I understand that submitting this information does not guarantee my acceptance as a volunteer, and that assignment of
volunteer work is based on the assessments made by the volunteer coordinator, Director, and staff.
I understand that if I have misrepresented any information and/or fail to adhere to volunteer guidelines, I may have my
application approval withdrawn.
I assume full responsibility for my actions and authorize the staff at the site I am volunteering to act on my behalf in the
event of an emergency.
I understand that the City reserves the right to complete a background/criminal check at any time. If fingerprints are
required, I agree to be responsible for the cost of fingerprinting.
I understand that I am responsible for informing the Park and Recreation Department of any changes to the above
information and not doing so will be grounds to terminate my role as a volunteer.
I hereby certify that all statements made and information submitted applicable to volunteering with the City of Des Moines, Iowa are true and contain no misrepresentation. *
Please Note: The term “convicted” includes a conviction following a trial, a guilty plea, a plea of nolo contendere or no contest,
a deferred judgment or adjudication, and an adjudication of guilt or delinquency as a minor or adult. A conviction will not
necessarily disqualify an applicant from volunteering. If you fail to report a conviction, you may be ineligible for volunteering
regardless of the nature or seriousness of the crime and regardless of the date of the conviction.
Have you ever been cited/fined/arrested for, charged with, or convicted of a criminal offense other than a minor traffic violation? *
If yes to the above, please explain and give dates.
Have you ever been listed on any sex offender registry? *
Have you ever been named in a founded case of child abuse or is there a current child abuse case pending against you? *
Has your driver's licensed ever been suspended or revoked for any reason? *
I understand that if I'm applying for a position that requires driving a vehicle or equipment, I will be required to submit a copy of a valid driver's license. *
Do you have a clean driving record for the past three (3) years? *
I am aware that all statements I have made and/or information I have submitted are subject to investigation and verification, including a criminal background check.
I understand that any withholding of information or misrepresentation of any statements I have made and/or information I have
submitted could result in disqualification or termination of volunteer service.
I understand that I am responsible for informing the City of Des Moines of any changes to the information above and that
failure to do so will be grounds to terminate my role as a volunteer.
I understand any offer of City of Des Moines volunteer positions is conditional upon satisfactory background checks, which
include criminal, sex offender, and if applicable, driving record; or any other that are deemed necessary by the City.
I understand that the City reserves the right to complete a background/criminal check at any time. If fingerprints are required, I
agree to be responsible for the cost of fingerprinting.
I hereby certify that all statements made and information submitted applicable to volunteering with the City of Des Moines,
Iowa are true and contains no misrepresentations to the best of my knowledge.
I understand a record of arrest or conviction does not necessarily prohibit me from volunteering and depends on the nature of
the offense, the type of service performing, and how much time has passed since the arrest or conviction. Expungement of a
conviction record or a deferred judgment does not eliminate the need to disclose those details on this form. This information
will be held in confidence, subject to Iowa Code Chapter 22, used only to evaluate applications, and only to the extent
permitted by applicable law.
I hereby consent to the City of Des Moines to request information pertaining to my criminal history. I authorize the investigation of all statements contained herein. *
Waiver
In consideration of me, or my minor child, being permitted to participate in any way in the above named Volunteer Program, I, the Undersigned, 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 Des Moines, 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, including illness or complications associated with the COVID-19 pandemic, 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 my or my minor child's participation in this volunteer service.
5. Assume full responsibility for any risk of bodily injury, including illness or complications associated with the COVID-19 pandemic, death or property damage arising out of or related to the volunteer service. I agree to comply with all applicable safety rules, including wearing protective clothing, close-toed shoes/boots, safety goggles, gloves, and vest while performing my volunteer activities.
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.
In consideration of me, or my minor child, being permitted to participate in any way in the above named Volunteer Program, I, the Undersigned, 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 Des Moines, 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, including illness or complications associated with the COVID-19 pandemic, 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 my or my minor child's participation in this volunteer service.
5. Assume full responsibility for any risk of bodily injury, including illness or complications associated with the COVID-19 pandemic, death or property damage arising out of or related to the volunteer service. I agree to comply with all applicable safety rules, including wearing protective clothing, close-toed shoes/boots, safety goggles, gloves, and vest while performing my volunteer activities.
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. I agree that this Agreement and Photo Release will be IN EFFECT for 5 YEARS from the date of my signature, unless otherwise terminated by me in writing delivered to the City.
