Volunteer Signup and/or Waiver

Form Name

WHICH OF THE FOLLOWING IS TRUE OF YOU?

I've never signed up before and need to complete both the Signup and the Waiver sections.I'm already signed up for a job but still need to complete the Waiver.I've completed a Waiver in the past.

Congratulations! Since you've already complete a Waiver in the past, you are all ready to go. All you need to do is show up at the job site on the day for which yoiu volunteered!

NAME*

First NameLast Name

HOME PHONE

Area CodePhone Number

CELL PHONE

Area CodePhone Number

EMAIL*

HOME ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

DATE OF BIRTH*

Date

GENDER*

MaleFemale

EMERGENCY CONTACT NAME

First NameLast Name

EMERGENCY CONTACT PHONE

Area CodePhone Number

EMERGENCY CONTACT RELATIONSHIP

If you are under the age of 18, you must have your case worker, probation officer or a responsible adult with you at all times.

TELL US A LITTLE BIT ABOUT WHY YOU WANT TO VOLUNTEER WITH HABITAT AND WHAT YOU'D LIKE TO GET FROM YOUR EXPERIENCE*

IN WHICH OF THE FOLLOWING AREAS WOULD YOU BE INTERESTED IN HELPING?

ARE YOU PART OF A GROUP WHO WILL BE VOLUNTEERING?*

YesNo

TYPE OF GROUP*

StudentChurchBusinessOther

GROUP/ORGANIZATION NAME:

PREFERRED LOCATION:*

ConstructionReStore

PLEASE SELECT IF APPLICABLE:

I am volunteering through community service programI have community service hours to fulfill

I WOULD LIKE TO VIEW RELEASE AND WAIVER OF LIABILITY.

YesNo

Release and Waiver of Liability

This Release and Waiver of Liability (the “Release”) is given by the undersigned person such as volunteers, community service participant, or program participants (collectively “Volunteer”) and is in favor of Habitat for Humanity International, Inc., a nonprofit corporation and Habitat for Humanity Lafayette, Inc., an Indiana nonprofit corporation and their directors, officers, employees, and agents (collectively “Habitat.)”

The Volunteer desires to work as a volunteer for Habitat and engage in the activities related to being a volunteer (the “Activities.”) The Volunteer understands that the Activities may include constructing and rehabilitating residential buildings, working in Habitat offices, working at the Habitat ReStore, and living in housing provided for volunteers of Habitat.

The Volunteer hereby freely, voluntarily and without duress, for and in consideration of Habitat’s mission to provide affordable housing for the needy and volunteer’s intention to advance that mission, Volunteer executes this Release under the following terms:

RELEASE AND WAIVER. Volunteer does hereby release and forever discharge and hold harmless Habitat and its successors and assigns from any and all liability , claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from Volunteer’s Activities with Habitat. Volunteer understands that this Release discharges Habitat from any liability or claim that the Volunteer may have against Habitat with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Volunteer’s Activities with Habitat, whether caused by the negligence of Habitat or its officers, directors, employees, agents, or otherwise. Volunteer also understands that Habitat does not assume any responsibility for or obligation to, provide financial assistance or other assistance, including, but not limited to medical, health, or disability insurance in the event of injury or illness.
MEDICAL TREATMENT. Volunteer does hereby release and forever discharge Habitat from any claim whatsoever which arise or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Volunteer’s Activities with Habitat.
ASSUMPTION OF THE RISK. The Volunteer understands that the Activities include work that may be hazardous to the Volunteer, including, but not limited to, construction, loading and unloading, transportation to and from the work sites. The Volunteer hereby expressed and specifically assumes the risk of injury or harm in the Activities and releases Habitat from all liability for injury, illness, death, or property damage resulting from the Activities.
INSURANCE. The Volunteer understands that, except as otherwise agreed to by Habitat in writing; Habitat does not carry or maintain medical, health or disability insurance coverage for any Volunteer. Each Volunteer is expected and encouraged to obtain his or her own medical, health and/or disability coverage.
PHOTOGRAPHIC RELEASE. Volunteer does hereby grant and convey unto Habitat all rights, title, and interest in any and all photographic images and video or audio recordings made by Habitat during the Volunteer’s Activities with Habitat, including but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.
OTHER. Volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Indiana, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Indiana. Volunteer agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause

IN WITNESS WHEREOF, Volunteer has executed this Release on:

Date

Volunteer Signature

FOR INDIVIDUALS UNDER THE AGE OF 18

Volunteer and the Guardian of Volunteer have carefully read this document, fully understand its contents, and sign it voluntarily. I state that I am the parent or legal guardian of the above Volunteer and that the above Volunteer is under the age of 18 years old. I understand children under the age of 16 are not permitted to volunteer unless they are part of an organized volunteer group and accompanied by a parent or guardian at all times. We further acknowledge that no one under the age of 18 will be allowed to use any power equipment or tools, work on a ladder, the roof, or scaffolding, or participate in any hazardous activity.

PARENT/GUARDIAN NAME

First NameLast Name

PARENT/GUARDIAN Signature

Please verify that you are human*