Contributor Intake Form

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Date of Birth*

Email Address*

example@example.com

How long are you available to contribute?*

1-2 weeks1 monthMore than a month (please specify)

Emergency Contact*

First NameLast Name

Emergency Contact Number*

Are there specific tasks you’re interested in?*

Do you have any experience in farming, gardening, or construction?*

NoYes (please specify)

Do you have any specific skills or qualifications?*

(e.g., carpentry, permaculture, project management, first aid)

Do you have any medical conditions, allergies, or dietary requirements we should know about?*

NoYes (please specify)

Are you comfortable with physical tasks like digging, lifting, or standing for long periods?*

YesNo (please specify)

Why are you interested in contributing with us?*

What do you hope to gain or learn from this experience?*

Will you require on-site accommodation?*

YesNo

Do you have your own transportation?*

YesNo

How did you hear about our project?*

Do you have any other comments or questions?*

Consent & Liability Disclaimer

1. Safety Awareness: I acknowledge that participating in farming, construction, or other physical tasks involves inherent risks, including but not limited to injury, illness, death or property damage. I will follow all safety instructions provided by the Sunshine Syntropics team to minimize these risks.

2. Personal Protective Equipment (PPE): I understand that I am responsible for bringing and wearing appropriate PPE, including enclosed shoes, a hat, gloves, and any other items necessary to ensure my safety during activities. I acknowledge that failure to wear PPE may increase the risk of injury.

3. Personal Insurance Responsibility: I confirm that I have my own health and accident insurance to cover any death, injuries or incidents that may occur while volunteering. I understand that Sunshine Syntropics and its affiliates are not responsible for providing insurance coverage.

4. Waiver of Liability: I release and hold harmless Sunshine Syntropics, its team members, and landowners from any claims, liabilities, or damages resulting from my participation in the volunteer program, except in cases of proven gross negligence or intentional misconduct.

5. Medical Treatment: In case of a medical emergency, I authorize Sunshine Syntropics to seek medical assistance on my behalf, and I accept full financial responsibility for any associated costs.

6. Voluntary Participation: I confirm that my participation is entirely voluntary, and I am free to withdraw at any time.

I understand and agree to the following terms above.

Client Signature*