Improve-a-Home Projects - 2018

A Program of Knights of Columbus Council 8600

VOLUNTEER'S AGREEMENT AND RELEASE FROM LIABILITY

1. Voluntary Participation: I acknowledge that I have voluntarily applied to participate in a project that is one of the Improve-a-Home Projects of the Knights of Columbus Council 8600 to take place on April 21, 2018. I understand that as a volunteer I will not be paid for my services. I further agree that my participation in the Project may be terminated at any time by the Knights of Columbus Council 8600 or by me.

2. Assumption of Risk: I am aware that participating in the project, I may be exposed to personal injury or death or damage to my property as a result of my activities, the activities of other volunteers, or the conditions under which my volunteer services are performed. With knowledge of these risks, I agree to accept any and all risks of personal injury or damage to my property, and I verify this statement by placing my initials here______.

3. Release: In consideration of the opportunity afforded me to participate in the Project, I hereby agree that I, my successors, assignees, heirs, guardians and legal representatives, will not make any claim against the Project or the Knights of Columbus Council 8600 or any of its affiliated organizations, or their officers, directors, or employees, or any suppliers of any materials or equipment that are used during the Project, any of the Project volunteers or sponsors, or any homeowner participating in the Project, for injury, death, or damage resulting from the acts or omissions of any person or entity, however caused, arising from my participation in the Project. Without limiting the generality of the foregoing, I hereby waive and release any rights, actions or causes of action resulting from personal injury to me or my death, or damage to my property, sustained in connection with my participation in the Project; provided, however, that the injury, death or damage was not caused by an act of omission that was reckless, wanton, intentional, or grossly negligent.

I further consent to the unrestricted use by the Project and/or any person authorized by them of any photographs, recordings, interviews, videotapes, motion pictures or similar visual or auditory recording of me created in connection with the Project.

4. Knowing and Voluntary Execution: I have carefully read this agreement and fully understand its contents. I am aware that this is a contract and a release of liability between myself and the Knights of Columbus Council 8600, Fairfax Station, Virginia, and I sign it of my own free will. By signing this agreement, I certify that I am eighteen years of age or older or if I am under 18 years of age, that I have delivered the written consent of my parent or guardian, below, to Knights of Columbus Council 8600 as a condition of participation.

Executed at (city) ______, Virginia, on ______2018

______

Volunteer (Print Name)Address (please print clearly)

______

Signature of Volunteer City State Zip

______

Consent signature of parent or legal guardian if volunteer Area Code Telephone

is not eighteen years or older

______

(Witness)

RELEASE

AUTHORIZATION FOR PARTICIPATING MINOR RELEASE FROM LIABILITY

(MUST BE ACCOMPANIED BY VOLUNTEER RELEASE FORM SIGNED BY PARENT)

Improve-a-Home Project - 2018

Name of minor ______

I represent and warrant Knights of Columbus Council 8600, Fairfax Station, Virginia, sponsor of various home repair projects known as Improve-a-Home Projects, that I am the parent or legal guardian of the minor named above. The above named minor has my permission to participate in an Improve-a-Home Project of Council 8600, currently scheduled for April 21, 2018.

On behalf of such minor and myself, I have signed a Volunteer's agreement and release of liability form and hereby agree to all of the terms and conditions of the release in regard to the minor stated above.

I am aware that in participating in the project, the above minor may be exposed to personal injury or death or damage to his/her property as a result of his/her activities, the activity of other volunteers, or the conditions under which the said minor's volunteer services are performed. With knowledge of these risks, I (parent/guardian) agree to accept any and all risks of personal injury or damage to his/her property, and I verify this statement by placing my initials here .

I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability between/among myself, said minor and Knights of Columbus Council 8600, and sign this of my own free will.

Executed (city) ______, Virginia, on ______2018

______

Parent/guardian (print) Address

______

Parent/guardian (signature) CityStateZip

______

Name of minor (print) Telephone

______

Name of minor (signature)Witness

MEDICAL TREATMENT AUTHORIZATION FOR PARTICIPATING MINOR

(Must be accompanied by Volunteer Agreement Release From and

Authorization for Participating Minor Form)

Name of Minor:______

(Please print)

I represent and warrant to Knights of Columbus Council 8600, Fairfax Station, Virginia as the sponsor of various home repair projects known as Improve-a-Home Projects, that I am the parent or legal guardian of the minor named above. The above named minor has my permission to participate in an Improve-a-Home Project currently scheduled for April 21, 2018. On behalf of such minor and myself, I have signed a Volunteer Agreement and Release from Liability Form (the “Release”) and hereby agree to all of the terms and conditions of the release.

In case of medical or dental emergency, I request that the Knights of Columbus Council 8600 through its representative at each project site attempt to contact me at the telephone number set forth below. However, I hereby give permission to the physician or dentist selected by the Knights of Columbus Council 8600 to hospitalize, treat, secure proper treatment, and order injections, anesthesia or surgery for the minor named above. A copy of this permission form may be accepted by and treated by the physical or dentist as equivalent to the original permission form.

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Signature of Parent/Guardian Date

Phone______

Address______

______

PLEASE COMPLETE THE FOLLOWING:

1Medical Insurance Carrier:______

Policy Number:______

2Family Doctor:______

Address:______

Phone:______

3Family Dentist/Orthodontist______

Address:______

Phone:______

4Any Drug or Food Allergies______

5Limitation on Activities______

6If I cannot be reached, please contact______

Phone______