Volunteer Waiver, Release, and Indemnity Agreement

Please fill out the following form completely. You must check the three "Agreement and Cerfification" boxes near the bottom of the form before it can be submitted. Checking those boxes confirms that you have read and understand the "Volunteer Waiver, Release, and Indemnity Agreement", and constitutes your signature on this electronic form.

Please Note: you may be required to sign a paper volunteer waiver form when reporting for volunteer work activities.

Contact Information:

Your Name:
Your Email:
Mailing Address:
City:
State:
Zip:
Home Phone:
Cell Phone:

Employer:

Please provide the following information about your employer. If unemployed or retired, enter that information in the "Name" box

Name:
Address:
City:
State:
Zip:
Work Phone:

Emergency Contact Information:

You must provide the name and phone number of an individual that we can contact in the event of an emergency

Contact Name:
Contact Phone:

Agreement and Certification:

The following boxes MUST be checked before you can submit this application. By checking the box you are, in effect, signing this application.

I hereby certify that I am 18 years of age or older.
   

I hereby certify that I have read the Northland Neighborhoods, Inc. "Volunteer Waiver, Release, and Indemnity Agreement", and will abide by the provisions of the Agreement.

   

I agree to allow Northland Neighborhoods, Inc. to use my name, voice, photo and likeness for promotional purposes without any cash considerations or payments..

NOTE: you may be required to sign a paper Volunteer Waiver form when reporting for volunteer work activities.


Donate to Northland Neighborhoods, Inc. and read more about our organization on Donors Edge