Individual Volunteer - ProjectMEND

All volunteers must be 18 years of age or 16 years old and supervised by an adult.

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employer or School(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Special Skills

I am interested in helping with: (Check all that apply)(Required)

Sanitizing Equipment

Repairing Equipment

Yard Work

Administrative

Data Entry

Social Media

Grant Writing

Outreach Events

Speakers Bureau

Special Events

Board Committee

Volunteer Projects

I am interested in helping(Required)

Monthly

Bi-Monthly

Weekly

Other

Days and times available:

Media

All volunteers must be 18 years of age or 16 years old and supervised by an adult.

I do hereby for myself, executors and administrators waive, release, and forever discharge any and all rights and claim for damages, including any claims of loss, damages or injury to my person or property arising from my volunteer work for Project MEND.

I acknowledge and agree that I must observe all federal, state, and local laws and all rules, regulations and policies of Project MEND.
I recognize and acknowledge that there are certain risks of physical injury to volunteers providing and/or engaging in volunteer activities, and I voluntarily agree to assume the full risk of any and all injuries, death, damages, or loss regardless of severity, that my minor child/ward or I may sustain because of said volunteer Activities.
I acknowledge and agree that my participation may cease at any time at my request or at the request and discretion of Project MEND.

I have read, understand, and acknowledge this release and have voluntarily executed this release. I certify that I am legally an adult, 18 years of age or older or at least 16 years old with adult supervision and therefore able to volunteer with Project MEND. I acknowledge that no payment will be given to me for the services rendered.

Volunteer Waiver and Release of Liability

By my signature on this form, I give my permission for Project MEND and its designee to make or use pictures, video, digital images, or other reproductions of me and to put these images to use without compensation in productions, publications, on the web, or other printed or electronic materials related to the role and function of Project MEND for educational and publicity purposes in perpetuity without further consideration from me. I understand that I will need to notify Project MEND if any changes to my situation occur that will impact this media release permission.

Applicant's Signature(Required)

Date

MM slash DD slash YYYY

Parent/ Guardian Signature (for minors)

Date

MM slash DD slash YYYY