Volunteer Registration Form

Volunteer Information
Name*

First NameLast Name
Birthdate*

MonthDayYear
Date
Gender*
Pronouns*
Education*
Contact Information
Personal Email*
example@example.com
Home Phone
Please enter a valid phone number.
Alternate Email*
example@example.com
Mobile Phone*
Please enter a valid phone number.
Preferred Email*
Preferred Phone*
Mailing Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip CodeCountry
Primary Address Type
Email
example@example.com
Emergency Contact Information
Emergency Contact Name*
Emergency Contact Phone*
Please enter a valid phone number.
References
First Reference Name*
Second Reference Name
First Reference Phone*
Please enter a valid phone number.
Second Reference Phone
Please enter a valid phone number.
First Reference Email*
example@example.com
Second Reference Email
example@example.com
Volunteer Profile
Volunteer Availability*
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Volunteer @ Society*
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DF Volunteer Role
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DF Volunteer Skills
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ASABC Volunteer Role
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ASABC Volunteer Skills
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BCMOS Volunteer Role
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BCMOS Volunteer Skills
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ConnecTra Volunteer Role
To select multiple options, hold the Shift key (for a range) or the Ctrl/Command key (for individual selections) while clicking.
ConnecTra Volunteer Skills
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DIGA Volunteer Role
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DIGA Volunteer Skills
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TETRA Volunteer Role
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TETRA Volunteer Skills
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VAMS Volunteer Role
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VAMS Volunteer Skills
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Disability Information
Disability Category
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Specific Disability
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Disability Details
Please provide additional details/information (if any)
Work Phone
Please enter a valid phone number.
Waiver
Participant's Release of Liability, Waiver of Claims, Medical Waiver, Assumptions of Risks and Indemnity and Image Consent

By signing this document, you will waive certain legal rights including the right to sue. Please read carefully.

ASSUMPTION OF RISKS

I AM AWARE THAT THERE IS POTENTIAL RISK FOR PERSONAL INJURY INVOLVED IN VOLUNTEERING. The Disability Foundation has six affiliated societies: Adaptive Sailing Association of BC (ASABC), British Columbia Mobility Opportunities Society (BCMOS), ConnecTra, Disabled Independent Gardeners Association (DIGA), Tetra Society, and Vancouver Adapted Music Society (VAMS). I freely accept and fully assume all such risks, dangers and hazards, including the possibility of personal injury (including but not limited to: bumps, bruises, cuts, scrapes, concussion, broken bones, infections, abrasions, hypothermia, death and/or property loss resulting from my participation in the Disability Foundation and affiliated societies (DF) volunteering activities.

Risk of injurires from activities may include (not an exhaustive list):

ASABC: Bone fractures, back pains, concussion, drowning, sunburn, contusions, lacerations, and sprains.

BCMOS: Hiking, Cycling and Paddling: Blisters, snake bites, deep cuts, burns, broken bones, sprained ankles, allergic reaction, rashes, poisonous berries, dehydration, heat stroke, altitude sickness, drowning, hypothermia, tendinitis, concussion (head injury), and Carpal Tunnel syndrome.

ConnecTra: Slips, trips, and falls, electrical, biological/infection, chemical, muscle pain, and burns.

DIGA: Infections, cuts, chemical burns, eye injuries from plants, sunburn, and muscle injury.

Tetra Society (including workshops/tools): Burns, blunt trauma, skewered, severed finger, deep cuts, chemical-related injuries, and machine-related injuries.

VAMS: Tendinitis, Dequevain's tenosynovitis, Carpal Tunnel syndrome, Bursitis, Thoracic outlet syndrome, strained vocal chords, and back, neck and shoulder strain.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

In consideration of approval to participate in BCMOS activities, I hereby agree as follows:
Place initials* TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against DF, it’s directors, officers, employees, volunteers, representatives, other volunteers and partner organizations (Disability Foundation and it’s affiliated societies, organization partners, and government entities) all of whom are hereinafter collectively referred to as “ The Releasees”;

Place initials* TO RELEASE THE RELEASEES from any and all liability for any loss, damage, injury or expense that I suffer, or my next of kin may suffer as a result of my participation in this activity due to any cause whatsoever INCLUDING NEGLIGENCE, BREACH OF CONTRACT OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE. I acknowledge my responsibility to ensure adequate medical, personal health, dental and accident insurance coverage, as well as protection of my personal possessions;

Place initials* TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to property of, or personal injury to, any third party resulting from my participation in DF activities;

Place initials* This agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives in the event of my death or incapacity;

Place initials* In entering into this Agreement, I am not relying upon any oral or written representations or statements made by the Releases other than what is set forth in this Agreement;

Place initials* I grant permission to DF and/or their designates to proceed in any manner they deem necessary in the case of a medical emergency involving myself. I am releasing the right for this information to be shared with DF volunteers, staff, and/or medical staff who are in contact or responsible for my (or my child/ward’s) participation in the program;

Place initials* DF and/or their designates often take photographs/videos of volunteers and staff while programs are operating. These pictures may be used for promotional purposes, training and public education. I give my permission for photographs/videos to be taken of myself/ my child/ward, and for these to be subsequently published.
Confidentiality

The volunteer will hold all the confidential information that the volunteer receives in trust for the sole benefit of the employer and in strictest confidence; protect all of the confidential information from disclosure and will not take any action that could reasonably be expected to result in any of the confidential information losing its character as the confidential informations and will take all lawful action necessary to prevent any of the confidential information from losing its status as confidential information; and except as required in the course of performing the volunteer duties and services hereunder, not: use, publish, disseminate or otherwise directly or indirectly disclose any of the confidential information to any third party; nor use the confidential information for any purpose.
I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY AFFIXING MY NAME ELECTRONICALLY BELOW, I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASEES.
Volunteer Name*
Signed Date*

MonthDayYear
Date
For Youth Volunteer (under 18 years old):

Parental/Guardian Consent Required
Parent/Guardian Name
Parent/Guardian Signature
I confirm that I am the parent or legal guardian of the minor volunteer and, by signing my name above, I agree to all terms of this waiver on their behal.
Volunteer Notes/Comments

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