• YOUTH VOLUNTEER APPLICATION

  • CONTACT INFORMATION

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  • Important Note: Because ASAS work in conjunction with the Department of Education, all adult volunteers will be required to undergo a State and Federal background check. All volunteers who are under 18 will be required to undergo a State and Federal background check when they reach the age of 18. At that time, ASAS will provide instructions and will pay for said backgrounds checks.

  • PERSON TO CONTACT IN THE CASE OF AN EMERGENCY

  • MEDICAL INFORMATION

  • PARENT LIABILITY/PARENT AUTHORIZATION

  • In consideration of my minor/ward being allowed to volunteer at the After-School All-Stars (ASAS) Program, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that:

    1. FOR MYSELF, SPOUSE AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERS, AND ASSUME FULL

    RESPONISIBLITY FOR MY CHILD'S VOLUNTEERISM; and, 2. I willingly agree to comply with the program's stated and customary terms and conditions for my child's volunteering. If however, I observe any unusual significant concern in my child's readiness for volunteering and/or in the program itself, I will remove my child from volunteering and bring such to the attention of the nearest official immediately; and, 3. I, for myself and of behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMIFY AND HOLD HARMLESS ASAS, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners, and leasers of premises used for the activity ("RELEASEES"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEEES OR OTHERWISE, to the fullest extent per-mitted by law.

    I HAVE READ THIS RELEASE OF LIABLITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

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  • CONSENT FOR TREATMENT

  • I understand that in case of emergencies, ASAS will make every effort to contact the parent(s)/guardian(s) before any treatment is given. In the event that we cannot be contacted, I hereby authorize the physician or hospital selected by ASAS to hospitalize, secure treatment for and to order injection, anesthesia, or surgery for my child. It is further understood that I (the parent/guardian) will assume full responsibility for any such treatment, including the payment of all costs and transportation and will hold the ASAS their officers, officials, agents and/or employees, harmless there from.

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  • AGREEMENT AND SIGNATURE

  • By submitting this volunteer application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions or other misrepresentations made by me on this application may result in my immediate dismissal.

    I agree, that if I am selected to be a volunteer at After-School All-Stars Hawaii, I will volunteer for at least 20 hours per quarter, said hours will be at the convenience of the program.

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