Interfaith Alliance of Oklahoma

301 Northwest 36th Street

Oklahoma City, OK 73118

Tel: (405) 237-8426

Email: tiaokc@gmail.com

 

© 2015 by TIA Oklahoma

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Please print out the form below, fill it out, and bring it with you on May 4th

WAIVER OF LIABILITY AND PHOTO RELEASE

 

The undersigned (the “Volunteer”) has agreed to work as a volunteer for Central Oklahoma Habitat for Humanity, Inc. (the “Habitat Affiliate”), an affiliate of Habitat for Humanity International, Americus, Georgia (“Habitat”).  Volunteer understands that many of the activities performed by volunteers of the Habitat Affiliate involve a risk of injury and/or property loss or damage, including the inherent risks associated with any on-site construction activities.

 

The Volunteer hereby expressly releases, relinquishes, and forever discharges the Habitat Affiliate and Habitat, and their respective successors and representatives (collectively, the “Released Parties”), of and from any and all claims, which the undersigned may have against the Released Parties arising out of volunteer service for the Habitat Affiliate and any and all related activities.

 

Additionally, Volunteer hereby authorizes Habitat and its Affiliate to take photographs of the Volunteer and to use or publish such photos (either still photos or film/video) as they see fit and waives any rights and any claims Volunteer might make regarding the taking or publishing of any such photos.

 

Please make sure ALL information is filled out for every volunteer with the appropriate signature(s).  Make sure once on a Habitat site you also sign in.

Thanks in advance for your cooperation.

 

PRINT Name and Addresses of Volunteer:

Mr.   /   Ms.   /   Mrs.   (circle one)

 

First Name                                                                                                    Last Name

Email Address

                                                                                                                         
Mailing Address
                                                                                                                         
City                                                                                                                   State                  Zip
                                                                                                     
Contact Phone with area code                                                             
                                              
Emergency Contact Phone and Name

 


Your Date of Birth example: (01 01 11)     
                                                                                                                   

________________________________________________
 Name of your group volunteering today                         


________________________________________________________________                    ________________
Signature of Volunteer                                                                              Date


________________________________________________________________                    ________________

Signature of Parent or Guardian                                                            Date
 (If Volunteer is under 18 years of age
  Parent/Guardian signature is required.)


Please circle age group that applies to you:
16-22            23-40         41-60        61+


Would you like to receive Habitat newsletter?                           Yes          No       Already Do


Would you like to receive Habitat  monthly e-Newsletter?    Yes          No       Already Do

 

 

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