Volunteer/Community Service Form

Name*

First NameLast Name

Email

example@example.com

Phone Number

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Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you wanting to complete Community Service hours or Volunteer?

Are you a College Student?

What College/School are you currently attending?

If “Volunteer”, which position fits you?

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If Community Service, how many hours are required?

What court jurisdiction?

Start Date

Date

COVID - 19 Release I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that ABDTYIP has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.I further acknowledge that ABDTYIP can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, and other clients and their families. I hereby release and agree to hold ABDTYIP harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself15and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from ABDTYIP. I understand that this release discharges ABDTYIP from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from ABDTYIP. This liability waiver and release extends to the salon together with all owners, partners, and employees.*

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Consent to Photograph /Videotape / Interview Individuals Please read, date and provide your signature on the next pages Terms & Conditions I hereby agree and give my permission for A Better Day Than Yesterday Initiative Program and/or partners to record, film, photograph, audiotape or videotape myself (hereinafter collectively referred to as “Works”) and to display, publish or distribute these Works for the purpose of publishing, posting on the A Better Day Than Yesterday Initiative Program website and posting on social media sites. I hereby waive any right to approve the use of these Works now or in the future, whether the use is known to me or unknown, and I waive any right to any royalties related to the use of these Works. I understand that the Works may appear in electronic form on the internet or in other publications outside of the A Better Day Than Yesterday Initiative Program’s control. I agree that I will not hold the A Better Day Than Yesterday Initiative Program responsible for any harm that may arise from such unauthorized reproduction.

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