Name ____________________________________ Address __________________________________________
City _______________________ Zip ____________ Phone (H)_____________________(W)_______________
Place of Worship_____________________________________________________________________________
Occupation/Employer ___________________________________Email_________________________________
Age: ______ Everyone Under 18 Must have a signed Release and Waiver of Liability for Minors.
Availability: (Circle) MON TUE WED THU FRI SAT
Are you interested in volunteering in the Habitat Office? The office is open Monday � Friday 9:00-5:00. Duties include general office work, data entry, bulk mailing, etc. YES NO
Would you like to volunteer in the Warehouse (M-F 9:00-5:00)? Duties include jobsite prep., etc. YES NO
Would you be willing to be a Site Host at the construction site? YES NO
Are you a member of a group that would be willing to furnish lunch for a work crew? YES NO
Would you like to volunteer on a committee? YES NO If yes please circle one below
Church Relations Fund Raising Site Selection Construction
Family Selection Family Support Public Relations
Do you have construction experience? If so, please list: ________________________________________
INDIVIDUAL WAIVER AND RELEASE OF LIABILITY
(THIS DOCUMENT IS IMPORTANT, SHOULD BE READ IN ITS ENTIRETY AND SIGNED)
In consideration of being allowed to participate in any way as a volunteer for the �FORT HOOD AREA HABITAT FOR HUMANITY, INC.� program, related events and activities, the undersigned:
1) Agrees, prior to participating, he/she will inspect the facilities and equipment to be used, and if he/she believes anything to be unsafe, will immediately advise his/her site supervisor of such condition(s) and refuse to participate.
2) Acknowledges and fully understands that he/she will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from his/her actions, inactions or negligence of others, or the condition of the premises or of any equipment used. Further, that there may be other risks not known or not reasonable foreseeable at this time.
3) Assumes all the foregoing risks and accepts personal responsibility for the damages following such an injury, permanent disability or death.
4) Releasee, waives, discharges and covenants not to sue the FORT HOOD AREA HABITAT FOR HUMANITY, INC.�, its respective administrators, directors, agents, site supervisors, and other employees/volunteers of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leaseholders of premises, all of which are hereinafter referred to as �releasees�, from demands, losses or damages on account of injury, including death or damage to property caused or alleged to be caused in whole or part by the negligence of the �releasee� or otherwise.
I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY. THIS FORM WAIVES LIABILITY FOR NEGLIGENCE. THIS AGREEMENT CANNOT BE MODIFIED ORALLY.
DATE
VOLUNTEER (PRINTED) VOLUNTEER (SIGNATURE)