Volunteer and Online Waiver Form

You must complete this form online or print one out and bring it into the habitat office before you can do any work on a Habitat house. This does not extend to supplying food.

THIS IS A LEGAL DOCUMENT. READ AND COMPLETE IT CAREFULLY.

Basic information
First Name:    M.I.:    Last Name:
Date of Birth:
I am a(n): High School Student College Student Adult
Note: If you are under 18 years old, please print this form and bring it in, as you need a parent/guardian's signature.

Address:
City: State:  Zip code:
Phone Number: ()  - 
Email Address:

Organization/Business/Church Affiliate (if applicable):

Skills, Volunteering, and Information
I am skilled in:


I would like to volunteer in another capacity for Habitat! My areas of interest are:
Office Assistance   Family Selection Committee   Site Selection Committee
Building Committee   Family Support Committee   Meal Provider
Development Committee   Church Relations Committee   ReStore Committee  

I would like to learn more about Habitat for Humanity:
Yes, please contact me.
No thank you.

Waiver

Release and Waiver of Liability (Includes Minors)
To be read and signed by all persons intending to do volunteer work for the Brookings Area Habitat for Humanity, Inc.

     The Volunteer (and Parent/Guardian) desire that the Volunteer work as a volunteer for Habitat and engage in the activities related to being a volunteer (the "Activities"). The Volunteer (and Parent/Guardian) understand that the Activities may include constructing and rehabilitating residential buildings, working in the Habitat offices and other related Habitat locations.

     Volunteer (and Parent/Guardian) understand that this Release discharges Habitat from any liability or claim that the volunteer may have against Habitat and its successors 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 (and Parent/Guardian) also understand 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.

     Parent/Guardian agree(s) to indemnify and forever hold harmless Habitat against any loss or expense from any Claims, demands or actions that may hereafter be made or brought against Habitat by or on behalf of any Minor for whom Parent/Guardian has signed this Release and Waiver of Liability.

Assumption of the Risk
     The Volunteer (and Parent/Guardian) understand that the Activities may include 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.

Medical Treatment
     Volunteer (and Parent/Guardian) do 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 OR for minors with the decision by any representative or agent of Habitat to exercise the power to consent to medical or dental treatment as such power may be granted and authorized in the Parental Authorization for Treatment of a Minor Child.

Drug Free Workplace
     This notice is written in pursuant to the Drug Free Workplace act, 41, USC 701 and the implementing regulations to 24 CFR 24. The Brookings Area Habitat for Humanity is a Drug Free Workplace. The unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance is prohibited in Habitat's workplace and program.

Photo/Web Waiver
     Volunteer (and Parent/Guardian) do 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 recording.

By signing this waiver you state that you have read and agree with the Release and Waiver of Liability.

To sign this form, please enter your full name in the signature box below.
Signature:

Submit
If you are sure everything in the above form is correct, press the submit button below.