VOLUNTEER FORM for ADULTS
— CONSTRUCTION or LANDSCAPING —
Please fill out all sides completely and print clearly
Work Date: ___________________________
Volunteering as part of a Group? _______ If yes, Group name: ___________________________________
Name: _____________________________________ E-mail: __________________________________
Address: ________________________________ City, State, Zip: _______________________________
Home Phone: __________________________ Work Phone: ____________________________
Cell / Alternate Phone: ________________________________
Place of employment: __________________________________
Date of birth: ____________________ Work Restrictions: _____________________________________
Volunteer Program: □ CASP □ Probation □ Sweat Equity □ Other:______________________
Number of service hours to complete: _______ Date for completion of service hours: _______________
Emergency Contact: ______________________________________ Phone: _______________________
(optional) Church affiliation: Yes No Name of church: ____________________________________
More information on Volunteering? Yes No
**Age requirements: Landscape volunteers (away from active construction site) must be at least 14 years old and bring appropriate supervision and parental permission. Construction and ReStore volunteers must be at least 16 years old, and minors under 18 are not allowed to operate power tools or motor vehicles, work from a height of six feet or more, or work on excavation or demolition projects.
If you are completing this form ahead of time, please bring it with you to the site when you volunteer. Thanks!
RELEASE AND WAIVER OF LIABILITY - Please Read Carefully! This Is A Legal Document That Affects Your Legal Rights!
This Release and Waiver of Liability (the "Release") executed on this ________ day of_______________, 20__, by _________________________________ (the "Volunteer") in favor of Habitat for Humanity International, Inc., a nonprofit corporation, and Habitat for Humanity of Springfield, Missouri, Inc., a Missouri nonprofit corporation, their directors, officers, employees, and agents (collectively, "Habitat"). The Volunteer desires to work as a volunteer for Habitat and engage in the activities related to being a volunteer (the "Activities"). The Volunteer understands that the Activities may include constructing and rehabilitating residential buildings, landscaping, and working in the Habitat ReStore or offices. The Volunteer hereby freely, voluntarily, and without duress executes this Release under the following terms:
Release and Waiver. Volunteer does hereby release and forever discharge and hold harmless Habitat and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Volunteer's Activities with Habitat. Volunteer understands that this Release discharges Habitat from any liability or claim that the Volunteer may have against Habitat with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Volunteer's Activities with Habitat, whether caused by the negligence of Habitat or its officers, directors, employees, or agents or otherwise. Volunteer also understands that Habitat does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness.
Medical Treatment. Volunteer does hereby release and forever discharge Habitat from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Volunteer's Activities with Habitat.
Assumption of the Risk. The Volunteer understands that the Activities included work that may be hazardous to the Volunteer, including, but not limited to, construction, loading and unloading, and transportation to and from the work sites. Volunteer hereby expressly and specifically assumes the risk of injury or harm in the Activities and releases Habitat from all liability for injury, illness, death, or property damage resulting from the Activities.
Insurance. The Volunteer understands that, except as otherwise agreed to by Habitat in writing, Habitat does not carry or maintain health, medical, or disability insurance coverage for any Volunteer. Each Volunteer is expected and encouraged to obtain his or her own medical or health insurance coverage.
Photographic Release. Volunteer does hereby grant and convey unto Habitat all right, title, and interest in any and all photographic images and video or audio recordings made by Habitat during the Volunteer's Activities with Habitat, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.
Other. Volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Missouri, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Missouri. Volunteer agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.
IN WITNESS WHEREOF, Volunteer has executed this Release as of the day and year first above written.
Volunteer:_________________________________ Witness:_______________________________ Updated 12/2008
