Grassroots Community Development Volunteer Form
Sign Up and Release of Liability Waiver
Hello!
Thank you for your interest in volunteering with Grassroots Community Development! We're glad to have you on our team.
Before you complete this form, please note the following details:
The following form is a general volunteer sign up form and a release of liability waiver. You will need to complete this form before you volunteer with Grassroots and once annually in subsequent years. If you have any questions, please call (254) 235-7358.
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you affiliated with a volunteer group? If so, please share their name.
Do you have any allergies or dietary preferences? If so, please share.
Back
Next
RELEASE OF LIABILITY AND PARENT PERMISSION FORM
Waco Community Development dba Grassroots Community Development
Required for the following activities: Volunteerism in Waco Community Development dba Grassroots Community Development programs and Construction/Work Projects
Whereas, the undersigned participant wishes to be accepted for participation in one or more of the activities listed above which is organized by Waco Community Development dba Grassroots Community Development, of Waco, TX and regarding Waco Community Development dba Grassroots Community Development action in allowing the applicant to participate in such activities or programs, the undersigned acknowledges that the activity does involve certain risks. The activities are designed to allow the participant to broaden their understanding of various Christian values, socio-economic differences, ethnic and racial diversity, cultural appreciation, team building, character development, and/or enrichment opportunities. These activities include those listed above, but are not limited to, and activities in a lower income neighborhood and among poor people in Waco, TX. I understand that participants are exposed to physical and psychological risk through elements of nature, travel by car, van, walking, or other conveyance, and direct contact with people from various backgrounds. Risks may also include damage or loss of personal property. I further understand that immediate medical treatment may be difficult or delayed. Risks may also include physical injury and/or strenuous physical activity at work/construction sites, or during other activities. In consideration of the above, I have and do hereby assume all the above risks and any other ordinary risk incidental to the nature of the program, including risks which are not specifically foreseeable, and will hold harmless and indemnify Waco Community Development dba Grassroots Community Development its Board of Directors, employees, agents, and/or Associates and the City of Waco and its employees, agents, officers and contractors from any and all liability. The terms hereof, and my signature on this document shall serve as a release and assumption of risk, and shall bind my heirs, representatives, executors, administrators, successors and assigns and for all members of my family, including any minors accompanying me. I also state that I am not under, and will not be under the influence of any non-prescribed chemical substance, including alcohol. I also state that I will assume responsibility for any damage or loss to physical property or expenses incurred due to negligent or irresponsible behavior. I understand that my participation in this Waco Community Development dba Grassroots Community Development program or activity is entirely VOLUNTARY. My signature also gives my permission and accepts financial responsibility, as well, for first aid treatment and/or professional medical attention if needed. I also give permission for photographing of myself or my child during the activities and use of those pictures or video by Waco Community Development dba Grassroots Community Development or the City of Waco.
Participant Signature
*
Date
*
-
Month
-
Day
Year
Date
PARENT/GUARDIAN SIGNATURE
FOR ANY PARTICIPANT UNDER AGE 18
Parent/Guardian Signature
Date
-
Month
-
Day
Year
Date
Additional Information
In Case of an Emergency
Participant's Age
*
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Emergency Contact
*
Continue
Continue
Should be Empty: