Volunteer Application

Your name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Home/Main Phone *

Work Phone

Cell Phone

Email *

Email

Confirm Email

Emergency Contact *

First

Last

Emergency Contact Phone *

Relationship:

Which do you prefer? *

Administrative Work
Home Repair/Construction

Please list your experiences

Please list the times and days of the week you are able to volunteer:

WAIVER AND RELEASE OF LIABILITY

I acknowledge that if participating in a client project without the approval of the Project Mend-A-House organization or staff is an act entirely at my own risk. I am also aware of the risk associated with traveling to and from as well as participating in a project, which may include, but are not limited to, physical or psychological injury, pain suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss and death.

I also acknowledge that Project Mend-A-House Board of Directors, Chief Executive Officer, staff, or any affiliates are not responsible for errors, omissions, acts, or failures to act of any party or entity conducting a specific project on behalf of my own acts.

I acknowledge that I have carefully read this document (waiver) presented by Project Mend-A-House and fully understand all my rights and responsibilities as outlined throughout this document.

I agree to the waiver and release Project Mend-A-House of all liabilities.

SIGNATURE *

By entering your name, you are agreeing to the WAIVER AND RELEASE OF LIABILITY.

Date *

******WAIVER AND RELEASE OF LIABILITY******

WAIVER AND RELEASE OF LIABILITY