Emergency Form and Waiver

Natural Building Workshop & Volunteer Form    

 

Todays date:                  Expected length or date of stay:

 

 

 

FIRST NAME:                                      LAST NAME:

 

DATE OF BIRTH:

 

ADDRESS:

 

CITY:                            STATE:                  ZIP CODE:                HOME PHONE:                 MOBILE PHONE: # 

 

What you hope to learn:

Skills you have to share:

 

Waiver:  (based on the release form from Habitat for Humanity)

I agree to volunteer my time, labor, services and expertise to this natural building project or class. I understand that I receive no wages in this program. The volunteer program will give me personal satisfaction and the opportunity to expand my experience and understanding level. I understand that the sponsors of this program cannot be liable for any injuries or illness that I or my dependents(s) may suffer. I expressly waive any such claim for compensation or liability on the part of Deanne Bednar, Kensington Park, Raisin River Institute, or any of the other instructors, sponsoring organizations or businesses. I understand that all normal personal, medical and accident insurance coverage is the responsibility of the volunteer.

 

Print your name:

 

Sign your name:

 

Today’s date:

 

 

DEPENDENTS ~ Name & birthday of dependent(s) less than 18 years of age covered by this waiver:

 

 

 

 

 

 

 

Emergency information:

YOUR NAME:

YOUR BIRTHDAY:

EMERGENCY CONTACT PEOPLE

NAME:                 Their work phone: #                        Their home phone:                   Their Cell phone: # 

NAME:                   Their work phone:                         Their home phone:                   Their Cell phone: #

 

 

 

OTHER INSTRUCTIONS in case of emergency:

Do you have allergies or other relevant medical conditions?

Food Considerations?     Need Medication?

Anything else that would be helpful for us to know?

 

INSURANCE INFORMATION: numbers or copies of cards.  (If you have coverage)