Please Read before signing:

I do hereby understand and/or confirm that:

- The information I have provided may be verified, and i give my permission to Special Olympics Mississippi to make inquiry of others including a criminal background check and or driving record check concerning my suitability to act as a Special Olympics Mississippi volunteer; I authorize and request other to make available to any duly authorized representative of Special Olympics Mississippi any information relevant to my position as a volunteer. I hereby waive any right I may have with regard to the release of this information to Special Olympics Mississippi.

- I authorize a review and full disclosure of all records, or any part thereof concerning myself by/t and hereby authorize disclosure thereof to Special Olympics Mississippi. The intention of th information to Special Olympics Mississippi in conjunction with my application to volunteer for th to be reviewed and disclosed may be public or private records, and may include those record be of a privileged nature; 1 understand these records may be reviewed from time to time;

- a photocopy or facsimile of this release from will be valid as an original hereof, even tho contain an original writing of my signature. I agree to indemnify and hold harmless Special C person to whom this request is presented and his/her agents and employees, from and agains and expenses, including reasonable attorneys' fees arising out of or by reason of complying w of volunteering for Special Olympics Mississippi may be dealing with confidential information in the strictest confidence;

- the relationship between Special Olympics Mississippi and volunteers is an "at will" arrangement, and it may be terminated at any time without cause by either the volunteer or Special Olympics Mississippi

- I grant Special Olympics Mississippi permission to use my likeness, voice and words in television, radio, film, or in any form to promote activities of Special Olympics Mississippi.

- I am responsible for informing Special Olympics Mississippi of ALL changes regarding application;

- I have been educated on the Special Olympics Mississippi Volunteer Code of Conduct an for protecting athletes from abuse. I agree to abide by these guidelines for the benefit and Special Olympics Program;

- I am responsible for following and abiding by the Volunteer Code of Conduct as outlined in Volunteer Event Handbook Supplement.