Volunteer Waiver – Central Delaware Habitat for Humanity

Volunteer Contact

Choose One of the Following:*

Adult Volunteer
Minor Volunteer

Date*

Name*

First Last

Gender

Male
Female
Prefer not to say

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone

Cell Phone

Alternate Phone

Preferred Phone*

Primary Phone
Cell Phone
Alternate Phone

Email*

Date of Birth*

Employer

Occupation

Group Name

This box to be filled out only by individuals who are registering as a member of a group, such as a company, religious, or civic organization.

Other Community Groups You Participate In:

This information is for CDHFH only. The information provided will be used for notifying you of CDHFH activities and other solicitations.

Hours

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
ReStore	CLOSED	CLOSED	10 a.m. – 6 p.m.	10 a.m. – 6 p.m.	10 a.m. – 6 p.m.	10 a.m. – 6 p.m.	10 a.m. – 4 p.m.
Build Site	CLOSED	CLOSED	CLOSED	8 a.m. – 2 p.m.	CLOSED	CLOSED	8 a.m. – 2 p.m.

Where would you like to work?

Build Site (Must be 18 or older)
ReStore (Must be 15 or older. 15 & 16 must be accompanied by an adult.)
Events

Medical Information

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Alternate Phone

Relationship to You:*

Please list all medical conditions and/or medications:

Please list all allergies:

Can you lift 50 pounds or more?*

Yes
No

Service Information

Have you done community service before?*

Yes
No

If yes, please explain where and what:

Are you here to do community service hours?*

Yes
No

If yes, how many hours do you need to complete?

Are your community service hours by court order?*

Yes
No

If yes, please explain the charges against you:

Have you ever been convicted of a felony?*

Yes
No

If yes, please explain;

Are you currently on probation?*

Yes
No

If you answered yes, please list your probation officer’s contact information. A copy of your license is required.

Probation Officer Name

County

Probation Officer's Phone

Probation Officer's Email

Are you currently enrolled in a special program or organization that requires you to volunteer or do community service?*

Yes
No

If yes, please list program/organization:

Have you done community service at the CDHFH ReStore before?*

Yes
No

Release and Waiver of Liability

THIS RELEASE AND WAIVER OF LIABILITY (the “Release”) is made by the Volunteer named on page 1 (the “Volunteer”) in favor of CENTRAL DELAWARE HABITAT FOR HUMANITY (CDHFH or Habitat), a Delaware non-profit corporation and its directors, officers, employees, and agents.

The volunteer desires to participate in a CDHFH project and the activities related to the project. The volunteer understands that the activities may include but are not limited to the following:

a) On-site house building in Kent County, Delaware.

b) Travel to and from lodging or residence.

c) Any other activities related to CDHFH (e.g. promotions, entertainment, special events)

The volunteer does hereby freely, voluntarily, and without duress execute this release under the following terms:

1. WAIVER AND RELEASE: The volunteer does hereby release and forever discharge and hold harmless CDHFH and their successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or equity, which arise or may hereafter arise from the volunteer’s participation in Habitat’s project(s). The volunteer understands that this release discharges Habitat from any liability or claim that the volunteer may have against CDHFH with respect to any bodily injury, personal injury, illness, death, or property damage that may result from the volunteer’s participation in Habitat’s project(s). The volunteer also understands that CDHFH does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance.

2. MEDICAL TREATMENT: The volunteer does hereby release and forever discharge CDHFH from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the volunteer’s participation in CDHFH project(s). The volunteer understands that s/he is responsible for securing appropriate medical insurance coverage.

3. ASSUMPTION OF RISK: The volunteer understands that the CDHFH building project may include activities that may be hazardous to the volunteer and that the food and accommodations may be donated by CDHFH and beyond the control of CDHFH. The volunteer hereby expressly and specifically assumes the risk or harm in their activities and releases CDHFH from all liability from injury, illness, death or property damage and/or theft resulting from the activities of the volunteer’s participation in CDHFH project(s). CDHFH retains the right to limit or prohibit participation of the volunteer in the activities of the project(s) if CDHFH determines that such participation will not be in the best interests of CDHFH or the volunteer. The volunteer understands that s/he will be responsible for the payment of any expenses incurred as a result of application of this section.

4. PHOTOGRAPHIC RELEASES: The volunteer does hereby grant and convey unto CDHFH all right, title, and interest in any and all photographic images and video or audio recordings made by CDHFH during Habitat’s project(s).

5. OTHER: The volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Delaware, and that this release shall be governed by and be interpreted in accordance with the laws of the State of Delaware. The volunteer agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such a clause or provision shall not otherwise affect the remaining provision of this Release which shall continue to be enforceable.

IN WITNESS WHEREOF, the volunteer has executed this Release as of the day and year first above written.

I acknowledge that the information above is correct and a background check is required before I begin volunteering at Central Delaware Habitat for Humanity.

Volunteer: Please print your name, sign, and date below.

Name*

First Last

Signature*

Date*

If you are under the age of 18, a parent or guardian must also sign.

Parent/Guardian Name

First Last

Date

In Case of Emergency, Contact:

Name*

First Last

Relationship*

Phone*

CAPTCHA