AGREEMENT
I understand that Good Works Farm, Inc. Summer Enrichment Program is a drug-free, smoke-free and alcohol-free environment. By submitting this application, I have read and agree to the above rules and regulations.
BACKGROUND CHECK
I understand by completing this application, I give permission for Good Works Farm to run my name through the criminal records database. If further scrutiny is required, I will be responsible for securing my own FBI/BCI background check before being considered for placement as a volunteer. I will provide a copy of my driver’s license to verify my identity.
CONFIDENTIALITY
All registrants of Good Works Farm, Inc. Summer Enrichment Program have a right to know that all personal records, documents and conversations shall remain confidential. No information which might individually identify a registrant with a disability will not be released by any staff member or volunteer of Good Works Farm, Inc. to anyone outside the organization without the registrant’s expressed, written consent. I have carefully read and understand the Confidentiality Policy and agree to serve as a volunteer in accordance with this policy.
MEDIA RELEASE
I grant permission to Good Works Farm, Inc. to use my name and/or image in any media, either alone or accompanied by any other material. I agree that I will not hold Good Works Farm, Inc. responsible for any liability resulting from the use of my name and/or image in the manner described above.
RELEASE OF CLAIMS
I hereby waive, give up, and release Good Works Farm, Inc. including directors, officers, staff members, and agents, from any and all claims arising from any injuries, accidents, illnesses or other mishaps occurring to me during my volunteer activities at Good Works Farm, Inc.. My intention is to release and hold harmless Good Works Farm, Inc. parties from any claims which may have in the future regardless of its cause arising from activities which I decide to undertake at Good Works Farm, Inc.
AUTHORIZATION
I certify that the facts above are true and complete to the best of my ability and that falsified statements are grounds for dismissal. I authorize investigation of all statements herein and any references and employers listed to give you any and all information concerning my employment, experience, and any pertinent information they may have, personal or otherwise, and release Good Works Farm, Inc. from all liability for any damage that may result from utilization of such information. I understand that submitting an application does not guarantee admittance into Good Works Farm, Inc. Summer Enrichment Program. Applicant’s Initials _______