Recurring Payment

Student Volunteer Application
Name*

First NameLast Name
Email*
example@example.com
Cell Phone Number*
Format: (000) 000-0000.
School District*

DistrictCampus
Emergency Contact*

Full Name

Relationship

PhoneRelationship

Postal / Zip Code
WebsiteSpecial EventSocial MediaFriend or FamilyMy SchoolOther
Office / AdminCresson Pod Empowerment CenterFood PantryDriver / TransportationSpecial EventsUnited We Serve Community Days of ServiceI'm not quite sure.

Volunteer Availability

Rows	Not available	Morning	Afternoon	Evening
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Volunteer Release of Liability and Confidentiality Agreement
I name* the undersigned, hereby release and agree to hold harmless UNITED WAY OF HOOD COUNTY, its members, affiliates, and employees or executives of any and all liability that could possibly be incurred as a result of my negligence, intentional or unintentional, during my service as a UNITED WAY OF HOOD COUNTY volunteer. I further release and hold harmless UNITED WAY OF HOOD COUNTY, its members, affiliates, and employees or executives of all liability with regard to any physical or emotional harm that I may sustain during the time I volunteer at UNITED WAY OF HOOD COUNTY, or as a result of my participation in any project as a volunteer, or in any other activity sanctioned by UNITED WAY OF HOOD COUNTY.
My role is as a volunteer, and as such, I will receive no financial reimbursement for services rendered.I will bring to the attention of UNITED WAY OF HOOD COUNTY staff any concern of a legal nature.I recognize that any and all information shared with me as part of my duties as a volunteer is confidential and shall not be divulged to unauthorized individuals, agencies, or organizations.I will not copy, transcribe, record, or memorize confidential information of any kind, nor disclose or use such information for any purpose other than providing the assigned services at UNITED WAY OF HOOD COUNTY.
AGREEMENT shall be governed in accordance with the laws of the State of Texas. I have had the opportunity to read and understand the release and acknowledge that by signing the document, I am waiving certain legal rights in the event of injury. BY SIGNING BELOW, I accept and agree to the terms contained above.*
Date of Signature*

MonthDayYear
Date
I parent name ,as legal parent/guardian of minor name agree with the above.
Legal Parent / Guardian Signature
Date

MonthDayYear
Date
Should be Empty:

Student Volunteer Application

Volunteer Release of Liability and Confidentiality Agreement