Kids Serve 2024 Registration Form

Kids Serve 2024 Registration Form

Kids Serve is an opportunity for families in our community to come and learn more about the struggles of homelessness, as well as an opportunity for kids to put something together that would serve and benefit our residents. Feel free to contact Ray Choi, rayc@visionhouse.org if you have questions.
October 5, 2024 | 10:00am-12:00pm
450 Bremerton Ave NE, Renton, WA 98059
Participant's Name (Child's Name, ok to add multiple names)*

Child's First Name (ex: Johnny and Janie)Child's Last Name (ex: Smith)
Child's Age*

Age 5-11Other
Parent's Name*

Parent's First Name (ex: John and Jane)Parent's Last Name (ex: Smith)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Note: Some information have been pre-filled with information from previous screen.
Parent's Name*

Parent's First Name (ex: John and Jane)Parent's Last Name (ex: Smith)
Address*

Street Address

CityState / Province

Postal / Zip Code
Organization or Church (if applicable)
Phone*
Email*
example@example.com
Do you have any medical concerns that Vision House should know about? Other Comments?
RECOGNITION OF RISK & RELEASE OF LIABILITY (FOR ADULTS)

I understand that there are certain risks involved in participating in volunteer work that could potentially cause harm to the participants. These risks may include, but are not limited to, being around maintenance and construction activities, materials, machinery, tools, equipment, environmental factors, etc. | choose to participate notwithstanding such risks and with full knowledge of the perils and dangerous conditions thereof.

In full recognition and with assumption of these risks, but also in recognition of and in consideration for the value of participating in this volunteer opportunity, I, Parent's Full Name*, hereby release, waive and hold harmless Vision House, their members, employees and leadership and the leaders of this particular volunteer opportunity from any claim, demand, or cause of action for liability that I might have arising out of loss of or damage to property, bodily injury, death or other accident or circumstances which may occur in the course of this volunteer opportunity.

Vision House (VH) is in support of volunteers that choose to maintain relationships with former VH residents. In the case that a volunteer and a former VH resident choose to continue contact, VH encourages the volunteer and former resident to set respectable boundaries with one another. At that point, Vision House is no longer responsible for any liabilities/situations that may occur between the former VH resident and the volunteer.

This agreement shall be binding on the undersigned and their heirs, executors, administrators and successors of the undersigned.
Signature for Recognition of Risk & Release of Liability (Parents)*

Clear
Date*

MonthDayYear
Date
Emergency Contact & Relation to Volunteer*
Emergency Contact Phone #*
PHOTO RELEASE (optional)

I hereby grant to Vision House and its employees, agents and assigns, the right to photograph me and use the photo and/or digital reproduction or other reproduction of my physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the Internet.
Signature for Photo Release (Parents)

Clear
Date

MonthDayYear
Date

Note: Some information have been pre-filled with information from previous screen.
Participant's Name (Child's Name, ok to add multiple names)*

Child's First Name (ex: Johnny and Janie)Child's Last Name (ex: Smith)
Parent's Name*

Parent's First Name (ex: John and Jane)Parent's Last Name (ex: Smith)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization & Church
Parent Phone*
Parent Email*
example@example.com
Does participant have any medical concerns that Vision House should know about? Other Comments?
RECOGNITION OF RISK & RELEASE OF LIABILITY (FOR MINORS)

I am the parent/legal guardian of Child's Full Name*.

I understand that there are certain risks involved in participating in volunteer work that could potentially cause harm to the participants. These risks may include, but are not limited to, being around maintenance and construction activities, materials, machinery, tools, equipment, environmental factors, etc. I choose to participate notwithstanding such risks and with full knowledge of the perils and dangerous conditions thereof.

In full recognition and with assumption of these risks, but also in recognition of and in consideration for the value of participating in this volunteer opportunity, I, Parent's Full Name*, hereby release, waive and hold harmless Vision House, their members, employees and leadership and the leaders of this particular volunteer opportunity from any claim, demand, or cause of action for liability that I might have or that my minor child, Child's Full Name*, might have, arising out of loss of or damage to property, bodily injury, death or other accident or circumstances which may occur in the course of this volunteer opportunity.

This agreement shall be binding on the undersigned and their heirs, executors, administrators and successors of the undersigned.
Parent/Guardian Signature for Recognition of Risk & Release of Liability (Minor)*

Clear
Date*

MonthDayYear
Date
Emergency Contact & Relation to Minor Volunteer*
Emergency Contact Phone #*
PHOTO RELEASE (optional)

I hereby grant to Vision House and its employees, agents and assigns, the right to photograph my dependent and use the photo and/or other digital reproduction of him/her or other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the Internet.

I am the parent/legal guardian of Child's Full Name
Parent/Guardian Signature for Photo Release (Minor)

Clear
Date

MonthDayYear
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Should be Empty: