Volunteer Form

Personal Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact
Primary Contact Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Relation to you*
Secondary Contact Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Relation to you

Medical and Background Questions
Do you have any allergies? If so, please list.
Have you ever been convicted of a crime, felony, misdemeanor, forfeiture, or other criminal offense? If “yes,” attach an explanation describing the charge(s), legal jurisdiction, and date.*
Have you ever been convicted of an offense involving a minor, or endangering the welfare of a child such as child abuse, child neglect, etc. or an offense against a person, such as assault? If “yes,” attach an explanation describing the charge(s), legal jurisdiction, and date.*

Volunteer Questions
When would you like to Start volunteering?*
When would you like to End volunteering?*
Are you bringing anyone with you (family, friends, church group, etc.)? If so, how many?
Is there a specific project that you are wanting to volunteer for?
List special skills that you or those in your group might have.

Volunteer Release and Waiver of Liability Form
This Release and Waiver of Liability releases Northland Mission, Inc., hereby stated as Northland, a nonprofit corporation organized and existing under the laws of the State of Wisconsin and each of its directors, officers, employees, and agents. The Volunteer desires to provide volunteer services for Northland and engage in activities related to serving as a volunteer. Volunteer understands that the scope of the relationship with Northland is limited to a volunteer position and that no compensation is expected in return for services provided by volunteer; that Northland will not provide any benefits traditionally associated with employment to volunteer; and that Volunteer is responsible for his/her own insurance coverage in the event of personal injury or illness as a result of Volunteer’s services to Northland.
1. Waiver and Release: I, the volunteer, release and forever discharge and hold harmless Northland and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I provide to Northland. I understand and acknowledge that this Release discharges Northland from any liability or claim that I may have against it with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to Northland or occurring while I am providing volunteer services.
2. Insurance: Further I understand that Northland does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance. I expressly waive any such claim for compensation or liability on the part of Northland beyond what may be offered freely by Northland in the event of injury or medical expenses incurred by me.
3. Medical Treatment: I hereby release and forever discharge Northland from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a volunteer with Northland.
4. Assumption of Risk: I understand that the services I provide to Northland may include activities that may be hazardous to me including, but not limited to grounds, kitchen, housekeeping. As a volunteer, I hereby expressly assume risk of injury or harm from these activities and release Northland from all liability.
5. Photographic and Sending of Information Release: I grant and convey to Northland all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by Northland in connection with my providing volunteer services to Northland. I grant Northland the right to send me and/or my child information, including promotional materials.
6. Other: As a volunteer, I expressly agree that this release is intended to be as broad and inclusive as permitted by the laws of the State of Wisconsin and that this release shall be governed by and interpreted in accordance with the laws of the State of Wisconsin. I agree that in the event that any clause or provision of this release is deemed invalid, the enforceability of the remaining provisions of this release shall not be affected.
By signing below, I express my understanding and intent to enter into this Release and Waiver of Liability willingly and voluntarily.*

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Personal Information

Emergency Contact

Medical and Background Questions

Volunteer Questions

Volunteer Release and Waiver of Liability Form