Tetra Society Registration Form

Name*

First NameLast Name

Birthdate*

Date

Gender*

Pronouns*

Education*

Are you volunteering as an individual or with a school club? (Please specify school name if applicable) *

Personal Email*

example@example.com

Home Phone

Please enter a valid phone number.Format: (000) 000-0000.

Alternate Email*

example@example.com

Mobile Phone*

Please enter a valid phone number.Format: (000) 000-0000.

Preferred Email*

Preferred Phone*

Mailing Address*

Street Address

CityState / ProvincePostal / Zip CodeCountry

Primary Address Type

Email

example@example.com

Emergency Contact Name*

Emergency Contact Phone*

Please enter a valid phone number.Format: (000) 000-0000.

First Reference Name*

Second Reference Name

First Reference Phone*

Please enter a valid phone number.Format: (000) 000-0000.

Second Reference Phone

Please enter a valid phone number.Format: (000) 000-0000.

First Reference Email*

example@example.com

Second Reference Email

example@example.com

What motivates you to volunteer with the Tetra Society of North America?*

Please describe the skills, technical expertise, and relevant experience you bring to this role.*

Volunteer @ Society*

TETRA Volunteer Role*

To select multiple options, hold the Shift key (for a range) or the Ctrl/Command key (for individual selections) while clicking.

TETRA Volunteer Skills*

To select multiple options, hold the Shift key (for a range) or the Ctrl/Command key (for individual selections) while clicking.

YesNo

Please list the tools or workshop facilities you currently have access to for building and designing (e.g., 3D printer, soldering station, woodshop, etc).*

What other interests or skills do you want to contribute to the organization?*

YesNo

Minimum of 3 months1 yearOnly until completion of 1 projectAs long as my services are required

Please list any previous volunteer involvement (organizations, positions, dates, etc.)*

Current Employer (or if retired, immediate past)*

Yes, currently licensedYes, but currently non-practicing/retiredNoOther

If you are retired or non-practicing, please specify the year you retired and your province of last registration.*

YesNo

If yes, please fill out the disability categories and details.

Disability Category

To select multiple options, hold the Shift key (for a range) or the Ctrl/Command key (for individual selections) while clicking.

Specific Disability

To select multiple options, hold the Shift key (for a range) or the Ctrl/Command key (for individual selections) while clicking.

Disability Details

Please provide additional details/information (if any)

Work Phone

Please enter a valid phone number.Format: (000) 000-0000.

The success of our programs depends on volunteers conducting themselves in a highly ethical and professional manner. To ensure the safety and well-being of our clients, all volunteers are required to adhere to the following guiding principles and actions:

As a Tetra Society Volunteer, I shall:

Maintain client confidentiality at all times.
Ensure that you do not speak on behalf of the society without approval from Head Office.
When representing the organization on behalf of Tetra; ensure that the message adheres to the mandate of the society.
Commit to the highest level of professional efficacy through the maintenance and application of current, relevant knowledge and skill.
Demonstrate respect for the physical, emotional and spiritual well-being of a client.
Not provide assistive technology services when impaired by alcohol, drugs or other substances or any illness that could put the client at risk.
Treat all clients equitably and with respect.
Communicate all relevant information clearly to the client through verbal, non-verbal and/or written means while also establishing a feedback process to ensure mutual understanding.
Identify the interests of different clients and objectively address their needs.
Not exploit any relationship established as a volunteer to further their own physical, psychological, emotional, financial, political or business interests at the expense of the best interest of the client.
Maintain a respectful relationship with members of the public in order to facilitate awareness and understanding of assistive technology.
Maintain a respectful relationship with fellow volunteers and staff.

I have read and understood the Tetra Society Code of Ethics outlines above. By signing below, I agree to abide by these principles and understand that failure to adhere to this code may result in the termination of my volunteer position.*

Electronic Signature: (Type your full name here to provide your formal consent and agreement)

Signed Date*

Date

Volunteer'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.

* I understand that once I am registered as a Tetra volunteer, and as long as I am a Tetra volunteer, I am covered under Tetra's insurance when working on Tetra projects.

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.*

Electronic Signature: (Type your full name here to certify that you have read and agreed to all terms and conditions of this application)

Sign-up Date*

Date

Parent/Guardian Name

Type your full 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 behalf.

I understand the values and code of ethics of Tetra, and agree to conduct myself accordingly while actively volunteering and at any other time when I am associated with Tetra.I understand that materials and mileage costs for projects will be reimbursed. All financial transactions will happen through the Chapter Coordinator - not through the client.I understand and agree that Tetra may use devices (and/or its photographs) I create to promote and gain support for Tetra.I have read and understood the Exclusion of Liability, No Action, and Indemnity clauses outlined below. I understand that by signing below, I am waiving certain legal rights, including the right to sue.

EXCLUSION OF LIABILITY - not to hold Tetra Society of North America or its clients, directors, volunteers, officers, agents, representatives, employees, or assigns (collectively, the "Releasees"), or any of them, liable for any losses, damages or injuries that I may suffer, whether to person or property, howsoever caused, including negligence, breach of contract and breach of any statutory duty or other duty of care, on part of the Releasee, or any of them;NO ACTION - not to bring any action, proceedings, or claims against the Releasees, or any of them, for any losses, damages, or injuries that I may suffer, whether to person or property;INDEMNITY - to indemnify and hold harmless the Releasees and each of them from and against all claims, actions, costs, expenses, and demands brought by any person in respect of death, injury, damage or loss, whether to person or property, resulting from my participation with the Releasees and the delivery of the projects and services of Tetra Society of North America.

I HAVE READ AND AGREED TO THE TERMS AND CONDITIONS.

Volunteer Information

Contact Information

Emergency Contact Information

References

Volunteer Profile

Volunteer Commitment

Professional Credentials and Insurance

Disability Information

Tetra Society Volunteer Code of Ethics

Waiver

For Youth Volunteer (under 18 years old):