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2. 
4. Eagle Scout Name*
6. Address*
8. Email*
10. Home Phone*
11. Cell Phone*
13. Supervisor/Advisor for Project.
14. Supervisor Phone
16. Potential Number of Volunteers
18. Adults*
19. Youth 10-17*
    Groups with participants under 18 years of age should have responsible adult supervision.
20. Youth age 9 and under*
    Groups with participants under 18 years of age should have responsible adult supervision.
22. Check here if working independently

    1. Working Independently
26. Project Information
28. Project requires City staff supervision*

    1. Yes

    1. No
30. Task to be completed*
32. Location(s)*
34. Dates of project*
36. Tools/supplies needed*
38. Who will supply tools?*
40. Other comments
42. City staff recommends bringing a first aid kit.
46. Phone numbers for group to contact while working
48. Contact Name*
49. Contact Phone Number*
51. Contact Name
52. Contact Phone Number
54. The City of Burnsville reserves the right to refuse, cancel or revise this agreement. By clicking submit on this form the group acknowledges the hazardous nature of the work and agrees to comply with the terms and conditions herewith to the satisfaction of the City of Burnsville. Except for the negligent acts of the City, its agent and employees, the volunteers and their agents shall assume all liability for and hold the City, its agents and employees, harmless from, any and all claims for damages, action or causes or actions arising out of the work to be done. Any and all volunteers of the group or other persons while engaged in the performance of any work or service completed under this agreement shall not be considered employees of the City and any and all claims that may or might arise under the Worker's Compensation Act of Minnesota on behalf of said employees or other person while so engage, and any and all claims made by any third party of the group's volunteers or other persons while so engaged on any of the work or services to be rendered shall in no way be the obligation or responsibility of the City.
56. I understand and agree to the rules/regulations herewithin.*

    1. I agree
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field