Crumb Together Bakery Employment Application Form

Circle of Friends Crumb Together Job Training Workshop

July 13 - 4:00-5:30PM Location: Crumb Together Bakery: 40 King Street Norwalk
Personal Information
All information provided on this form will be used by Circle of Friends for the purposes of the organization and will be viewed by employees, officers, volunteers and agents of the Circle of Friends and may be disclosed by any of them in furtherance of the purposes of the organization and or the program or event in which the participant or volunteer is registering. For more information on the treatment of personal information collected by Circle of Friends please see our privacy statement which is available here:

View our Privacy Policy Here
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone number*

Area CodePhone Number
Home Phone Number*

Area CodePhone Number
E-mail*
Birth Date*

MonthDayYear
Emergency Contact Information*
Name
Relationship*
Cell Phone Number*

Area CodePhone Number
Medical Information
All information provided on this form will be used by Circle of Friends for the purposes of the organization and will be viewed by employees, officers, volunteers and agents of the Circle of Friends and may be disclosed by any of them in furtherance of the purposes of the organization and or the program or event in which the participant or volunteer is registering. For more information on the treatment of personal information collected by Circle of Friends please see our privacy statement which is available here:

View our Privacy Policy Here
Any special medical circumstances. *
Allergies*
Photo & Video Permission and Release
"I hereby expressly agree, without any right to inspect or approve finished product or use of images, to permit:

1.    The taking, use, reuse, publishing and republishing or photographic images of me including images in which I may be included in whole or in part, or composite or distorted in character or form without restriction as to changes or alterations from time to time, in conjunction with my name or fictitious name, or reproductions of such photographs in color or otherwise, made through any medium, and in any and all media nor or hereafter known, including the internet, for art, advertising, trade or any other purpose whatsoever;

2.    The use of any published content/matter in conjunction with such photographs; and

3.    The digital compositing, or distortion of the images, including without limitation any changes or alterations as to color, size, shape, perspective, context, foreground or background;

all in the furtherance of the mission of the Circle of Friends of Connecticut, Inc. (including advocacy or lobbying).

I hereby expressly assume responsibility for and fully release and hold harmless, Circle of Friends of Connecticut, Inc., its officers, employees, volunteers and agents, including any photographer engaged by any of them, from and against any claims for damage or loss relating to any of the forgoing.

This is to certify that I agree to this release as provided above.
Photo Release Sign Here*
Participation Assumption of Risk Waiver & Release of Liability
Participant Name*

First NameLast Name
In consideration of being allowed to participate in any way in the programs, related events and activities of the Circle of Friends. (including the "Crumb Together Bakery", “Home with Friends” program and events sponsored by any group associated with the Circle of Friends (including Beth Israel Chabad, Norwalk, CT) the undersigned, acknowledge and agree that:

1.     The risk of injury from the activities involved in any event or program is significant, including the potential for permanent paralysis and death. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM NEGLIGENCE OF THE RELEASEES or others and I assume full responsibility for my participation.

2.     I willingly agree to comply with rules and other terms and conditions for participation (“Rules”). If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of Circle of Friends immediately. I understand that any failure to follow Rules may end my participation in the program or event.

3.     I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Circle of Friends, its officers, volunteers, agents and/or any Beth Israel Chabad officers, employees, volunteers or agents, other participants and, if applicable, owners and lessors of any premises used to conduct the event or to transport me to or from the event (RELEASEES), from any and all claims, demands, losses, and liability (including attorney’s fees and costs) arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

4.     In the event of an injury requiring medical attention, I hereby grant permission to the officers, volunteers and agents at the program or event to seek emergency medical attention without further consent from me or my parent(s) or guardian and I understand and agree that I shall be responsible for all associated medical costs and related expenses whether or not covered by my own medical insurance.

I/We have read and understand this Assumption of Risk, Waiver and Release of Liability prior to signing it, and I/we am aware that by signing this Assumption of Risk, Waiver and Release of Liability I/we am waiving Substantial legal rights which I/we or my heirs, next of kin, executors, administrators, successors, and assigns may have against the Releasees. This liability waiver is made and executed in the State of Connecticut and shall be governed by, enforced in and construed in accordance with the laws of the State of Connecticut. I/we acknowledge that in executing this Assumption of Risk, Waiver and Release of Liability, I/we are not relying on any inducements, promises, or representations made by the Releasees.
Please sign and date in the appropriate box below.

DO NOT SIGN UNTIL YOU HAVE READ AND ANSWERED ALL OF THE INFORMATION CONTAINED IN THIS APPLICATION.
Participant Signature age 18 and over*

Clear
Date*

MonthDayYear
Date
FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER 18 AT TIME OF REGISTRATION)

This is to certify that I, as the parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incident to my minor child’s involvement or participation in the programs or events of Circle Friends, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. I expressly agree to grant the of permission and assume the obligation for payment of emergency medical and related expenses as set out in paragraph. 4 above.
Parent/Guardian Signature under age 18

Clear
Date

MonthDayYear
Date
Should be Empty:

Circle of Friends Crumb Together Job Training Workshop

Personal Information

Medical Information

Photo & Video Permission and Release

Participation Assumption of Risk Waiver & Release of Liability