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Volunteer Waiver
Prefix (Ms., Mr., Rev., etc.)
Optional Field
First Name
*
Last Name
*
Email
*
First & Last Names of Additional Family Members
If you are registering addtional adult or child members of your family, please list their first and last names here.
Street Address
*
City or Town
*
County (section of your state)
*
You can find your county at: http://statsamerica.org/CityCountyFinder/Default.aspx
State
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
ZIPCode
*
Daytime Phone
*
Allergies & Conditions to Be Noted
If anyone has a medical condition or allergy of which we should be aware, please list their name and condition.
Group, Organization, or Church (if applicable)
If you are volunteering as part of a group, please provide the name of the group.
Name of EMERGENCY CONTACT
*
Enter the name of an emergency contact person in case you have a medical problem.
Phone Number of EMERGENCY CONTACT
*
Phone number of contact person in case we need to call for assistance for you.
I have read and agree to the volunteer waiver.
*
Check if aged 18 or older.
*
Signature -- Typing your name in this box serves as your electronic signature on this form for yourself and on behalf of any minor children.
*
Date Added
10/05/2024
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