Vol 01 • Daily VolunteerRegistration

One day volunteers, Early Response Teams or PHP participants

Project site location: ______Date: ______

*Repeat day volunteers on the same project site are required to complete name, address and signature only.

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*Name: ______Phone: ______

*Street: ______*City: ______

St/ Zip/

*Prov ______*Post______Date of Birth: ______

E-mail: ______

EmergencyEmergency

Contact Name:______Phone:______

Name of Your Church:______

Denomination:______

Check to receive:

Behind the Hammer Bi-weekly Bi-weekly

(quarterly newsletter) e-mail update fax update

fax no.______

By completing this form I understand that MDS does not assume any responsibility for or obligation to provide financial assistance for medical, health or liability for any injury that may arise out of my activities with MDS. I acknowledge that the activities with MDS may be hazardous and entail risks of injury, illness, death and property damage. I agree to release and hold MDS, together with its employees, agents, directors, volunteers and board harmless from any claims or demands which may arise out of my activities with MDS. I further release and hold harmless any property owner whose property I am on as part of my activities with MDS.

*Signature: ______

Vol 01 • Daily Volunteer Registration

One day volunteers, Early Response Teams or PHP participants

Project site location: ______Date: ______

*Repeat day volunteers on the same project site are required to complete name, address and signature only.

------

*Name: ______Phone: ______

*Street: ______*City: ______

St/ Zip/

*Prov ______*Post______Date of Birth: ______

E-mail: ______

EmergencyEmergency

Contact Name: ______Phone:______

Name of Your Church:______

Denomination:______

Check to receive:

Behind the Hammer Bi-weekly Bi-weekly

(quarterly newsletter) e-mail update fax update

fax no.______

By completing this form I understand that MDS does not assume any responsibility for or obligation to provide financial assistance for medical, health or liability for any injury that may arise out of my activities with MDS. I acknowledge that the activities with MDS may be hazardous and entail risks of injury, illness, death and property damage. I agree to release and hold MDS, together with its employees, agents, directors, volunteers and board harmless from any claims or demands which may arise out of my activities with MDS. I further release and hold harmless any property owner whose property I am on as part of my activities with MDS.

*Signature: ______

MDS InstructionsMDS Instructions

  1. Each volunteer must register prior to serving on an MDS project.1. Each volunteer must register prior to serving on an MDS project.
  2. Send completed forms to Binational Office for projects in the US,2. Send completed forms to Binational Office for projects in the US,

or Region V Office for projects in Canada. or Region V Office for projects in Canada.

  1. Projects are not required to keep this form on file in the project office.3. Projects are not required to keep this form on file in the project office.

MDS Binational Officemds.mennonite.net MDS Region V Office MDS Binational Officemds.mennonite.net MDS Region V Office

583 Airport Road6A-1325 Markham Road583 Airport Road 6A-1325 Markham Road

Lititz, PA 17543Winnipeg MB R3T 4J6Lititz, PA 17543 Winnipeg MB R3T 4J6

tel: (717) 735-3536 fax: (717) 735-0809tel: (204) 261-1274 fax: (204) 261-1279 tel: (717) 735-3536 fax: (717) 735-0809 tel: (204) 261-1274 fax: (204) 261-1279

Revised: 4/14/2016