Scroll to see more shifts & complete your submission at the bottom of the page.Click here to scroll down.
Waiver
Who is this registration for?
Please provide a name and email address for a parent or guardian who can sign for you.
Parent/guardian first name:
Parent/guardian email:
ADULT VOLUNTEER WAIVER AND AUTHORIZATION
Authorization:
I declare that I have valid medical approval and am mentally able to participate in the activities of Shepherd Community, Inc. My health information provided herein is correct so far as I know, and I can engage in all prescribed program activities except as noted. I further understand that neither Shepherd Community, Inc. nor any of its paid staff or volunteer workers can be held responsible in the event of an accident or injury to myself. I hereby release Shepherd Community and its staff and volunteers from any liability for injury, illness or other harm I may incur while participating in such activities. I certify that I am free from habits or attitudes, which would make me an undesirable participant.
Transportation Agreement:
By my signature below, I hereby release Shepherd Community, Inc. staff and volunteers from liability for injury, illness or other harm which may arise as a result of my traveling by bus or van with employees of Shepherd Community, Inc. This would be for transportation to and from any Shepherd Community, Inc. sites. I understand that only licensed and qualified personnel will operate any vehicle to and from the site, and that there will be at least one staff member present at all times.
Emergency Authorization:
I authorize any representative of Shepherd Community, Inc. to seek medical attention for me when immediate medical care is warranted by the circumstances. I further authorize the health care professional selected by Shepherd Community, Inc. to provide me with the necessary care and treatment. I hereby release Shepherd Community, Inc., its staff and volunteers from any liability for injury, illness or other harm I may incur as a result or in connection with such treatment.
Photograph/Video Authorization:
Shepherd Community, Inc. and partnering organizations/companies with Shepherd Community have my permission to use photographs/videos of me: (a) in the promotional and informational material of Shepherd Community (including Shepherd’s Facebook page); and (b) in the promotional and informational material of partnering organizations/companies with Shepherd.
ADULT VOLUNTEER WAIVER AND AUTHORIZATION
Authorization:
I declare that I have valid medical approval and am mentally able to participate in the activities of Shepherd Community, Inc. My health information provided herein is correct so far as I know, and I can engage in all prescribed program activities except as noted. I further understand that neither Shepherd Community, Inc. nor any of its paid staff or volunteer workers can be held responsible in the event of an accident or injury to myself. I hereby release Shepherd Community and its staff and volunteers from any liability for injury, illness or other harm I may incur while participating in such activities. I certify that I am free from habits or attitudes, which would make me an undesirable participant.
Transportation Agreement:
By my signature below, I hereby release Shepherd Community, Inc. staff and volunteers from liability for injury, illness or other harm which may arise as a result of my traveling by bus or van with employees of Shepherd Community, Inc. This would be for transportation to and from any Shepherd Community, Inc. sites. I understand that only licensed and qualified personnel will operate any vehicle to and from the site, and that there will be at least one staff member present at all times.
Emergency Authorization:
I authorize any representative of Shepherd Community, Inc. to seek medical attention for me when immediate medical care is warranted by the circumstances. I further authorize the health care professional selected by Shepherd Community, Inc. to provide me with the necessary care and treatment. I hereby release Shepherd Community, Inc., its staff and volunteers from any liability for injury, illness or other harm I may incur as a result or in connection with such treatment.
Photograph/Video Authorization:
Shepherd Community, Inc. and partnering organizations/companies with Shepherd Community have my permission to use photographs/videos of me: (a) in the promotional and informational material of Shepherd Community (including Shepherd’s Facebook page); and (b) in the promotional and informational material of partnering organizations/companies with Shepherd.
Please sign here to show you accept the terms stated above for yourself or for a minor volunteer for which you are a parental guardian.
STUDENT VOLUNTEER AND WAIVER AUTHORIZATION
Parent Authorization:
I declare my child, who is under 18 years old, has valid medical approval and is mentally able to participate in the activities of Shepherd Community, Inc. My child’s health information provided herein is correct so far as I know, and my child has permission to engage in all prescribed program activities except as noted. I further understand that neither Shepherd Community, Inc. nor any of its paid staff or volunteer workers can be held responsible in the event of an accident or injury to my child. I hereby release Shepherd Community and its staff and volunteers from any liability for injury, illness or other harm my child may incur while participating in such activities. I certify that my child is amenable to discipline and free from habits or attitudes, which would make him/her an undesirable participant.
Transportation Agreement:
By my signature below, I give permission for my child to travel by bus with employees of Shepherd Community, Inc. at any Shepherd Community location, including, but not limited to Shepherd Community’s sports facility. This would be for a field trip or transportation to and from the sites. I understand that only licensed and qualified personnel will operate any vehicle to and from the site, and that there will be at least one staff member present at all times. I hereby release Shepherd Community, Inc. staff and volunteers from liability for injury, illness or other harm which may arise as a result of my child’s participation in these trips.
Emergency Authorization:
I authorize any representative of Shepherd Community, Inc. to seek medical attention for my child when immediate medical care is warranted by the circumstances and I cannot be reached, or if under the circumstances there is no time to attempt to reach me because of the nature of the injury or illness. I further authorize the health care professional selected by Shepherd Community, Inc. to provide the necessary care and treatment for my child. I hereby release Shepherd Community, Inc., its staff and volunteers from any liability for injury, illness or other harm my child may incur as a result or in connection with such treatment.
Photograph/Video Authorization:
Shepherd Community, Inc. and partnering organizations/companies with Shepherd Community have my permission to use photographs/videos of my child: (a) in the promotional and informational material of Shepherd Community (including Shepherd’s Facebook page); and (b) in the promotional and informational material of partnering organizations/companies with Shepherd.