nciap.org - Volunteer Form

VOLUNTEER SERVICE FORM AND WAIVER

NCIAP
Volunteer Information
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email Address
example@example.com
Stewardship Program Group Name:
Is the applicant over 18 years old?

YesNo
The minimum age for Volunteering with NCIAP is 14 years old. Is the applicant 14 years or older?

YesNo
If Applicant is under 18 years of age, please have parent or legal guardian signature below:
Parent/Legal Guardian Name:
Date

MonthDayYear
Date
Parent/Legal Guardian Signature:

Clear
Date

MonthDayYear
Date
Emergency Contact Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship
THIS INFORMATION MUST BE COMPLETED AND RETURNED TO NCIAP BEFORE YOU MAY VOLUNTEER. FAILURE TO PROVIDE COMPLETE AND ACCURATE INFORMATION MAY EXCLUDE YOU FROM VOLUNTEERING.

Please read and complete the information below:
In consideration of being a volunteer for NCIAP, I do hereby assume the risk of injury and all medical expense incurred from any injury resulting from my volunteer participation. I understand that I am to receive no payment for services from NCIAP. I am not an employee. I understand, acknowledge and agree I am not covered by Workers' Compensation insurance or benefits provided there under and I do hereby release, discharge and hold harmless NCIAP, its representatives and employees, from any and all claims whatsoever, known or unknown, for damages or injuries to myself.

Photography Release - By signing this form, the volunteer and/or parent or legal guardian permits the NCIAP to use pictures and/or videos of volunteers (including children) as a program participant in promotional literature, videos and the NCIAP website.
Applicant Name:
Date:

MonthDayYear
Date
Applicant Signature:

Clear
Date:

MonthDayYear
Date
Parent/Guardian Name:
Date:

MonthDayYear
Date
Parent/Guardian Signature:

Clear
Date:

MonthDayYear
Date
If under 18, signature of parent/guardian is required
Should be Empty:

VOLUNTEER SERVICE FORM AND WAIVER

Volunteer Information

Emergency Contact Information