National Volunteer Form for City Serve, 180 Disaster Relief, and

Contact Information

* required information

Your First Name

Your Last Name

Church or Organization

Date of Birth

COMPLETE THIS SECTION ONLY IF VOLUNTEER IS A MINOR:

Minors between 8 and 12 years of age must have a family member accompany minor at all times on the mission trip. Minors 13 through 17 years of age must be accompanied by a designated adult at all times, which is not required to be a family member.

Agreement for Minors

By checking the box on the left, I attest that this Faith Responder is a minor under the age of 18 and at least 8 years of age.

Name of Adult Accompanying Minor

Parent/Guardian's Signature

Street Address Line 1

Street Address Line 2

City

State

Zip

Phone

Your Email Address

Gender

Male Female

Emergency Contact Name

Emergency Contact Phone

Do you have any physical condition(s) that we need to know about?

Yes No

If yes, please describe

Have you had a tetanus shot within the last 10 years?

Yes No

If so, please indicate tetanus date

Please list any training or skillset that may be helpful in our mission:

Release, Waiver of Liability, and Indemnification Agreement

I wish to enter upon a missionary venture for the purpose of helping in times of disaster for the glory of God and to demonstrate my faith in Christ. I understand that I am acting as a volunteer and will therefore be responsible for paying my own expenses, including all types of insurance.

Release, Waiver of Liability, and Indemnification Agreement

By checking the box on the left, I agree to the following:
I understand that CityServe, 180 Disaster Relief, and Hopeful Restoration Group dba Spokes Of Hope cannot guarantee the safety or condition of the work sites. I understand volunteers may participate in a wide variety of construction-related activities, including but not limited to demolition, roofing, carpentry, dry-wall and ceiling installation, plumbing, masonry, glasswork, insulating, painting, flooring, electrical wiring, and other home repair, remodeling, and renovation. I also understand power tools such as saws and drills may be used, and activities may include climbing and working on roofs and ladders. I understand that I am not required to participate in any activities and should participate in only those activities that I am comfortable with. I am also, aware that the work may be hazardous, and I could be potentially exposed to hazardous materials, including lead, asbestos, and mold. I am fully aware of the risks, dangers, and other hazards to me and other members of the Disaster Relief Team, including physical injury or even death, whether at the disaster site, travelling to and from the work areas, in or about the living, sleeping and eating areas, or during other activities of the Disaster Relief Team. Nevertheless, I have elected to voluntarily participate, knowing that my participation may be hazardous to me and my property. In consideration for my being allowed to attend and participate in this missionary venture and any related activity, I am knowing, freely, voluntarily, and fully assume all risks and hazards, both known and unknown, of any loss, property damage, or personal or bodily injury, including death, that may be sustained by me, or loss of or damage to my property, as a result of my participation. I further assume all responsibility for my acts or omissions and any losses, injuries, or damages they may cause. I further release, waive, discharge, and covenant not to sue CityServe, 180 Disaster Relief, Hopeful Restoration Group dba Spokes Of Hope, Property Owner, any sponsoring or referring church or other organization, and their respective affiliates, directors, officers, employees, servants, agents, successors, and assigns (collectively referred to as the “Released Parties and Property Owner”), from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, related to my participation in the missionary venture, including all activities and transportation to and from the disaster site, even if arising from the negligence of the Released Parties or Property Owner, except that which is the result of their gross negligence or wanton misconduct. I further agree to defend, indemnify, and hold harmless the Released Parties and Property Owner from any and all claims, losses, injuries, and damages arising out of or in any way related to my participation in the missionary venture, including but not limited to claims by third parties and any claims submitted by me or on my behalf, even if arising from the negligence of the Released Parties or Property Owner, except that which is the result of gross negligence or wanton misconduct of the Released Parties and Property Owner.

In further consideration for my being allowed to participate in the missionary venture, I authorize CityServe, 180 Disaster Relief, and Hopeful Restoration Group dba Spokes Of Hope to record my picture and voice on photographs, films, audiotapes, and/or videotapes (collectively, the “Recordings”) and to incorporate and use the Recordings in any manner of media whatsoever, including unrestricted us of recordings for purposes of education, publicity, research, marketing, and advertising. I grant and convey to CityServe, 180 Disaster Relief, and Hopeful Restoration Group Dba Spokes Of Hope all of my right, title, and interest in all such recordings. I acknowledge that CityServe, 180 Disaster Relief, and Spokes of Hope cannot control the content of images, video, or audio recordings reproduced or posted on the web by third parties, including other volunteers, and for the consideration stated herein waive and release any and all claims and actions against the Released Parties and Property Owner for any such reproductions and postings. It is my expressed intent that this agreement shall also bind the members of my family and spouse, if I am alive, and my heirs, assigns, and personal representatives, if I am deceased, and that it be enforced to the maximum extent permitted by law.

Alcohol & Substance Abuse Agreement

By checking the box on the left, I agree to the following:
CityServe, 180 Disaster Relief, and Spokes of Hope has a ZERO tolerance for alcoholic beverages, substance abuse, illegal drugs (and the like) on the mission field. No alcohol or other similar substances can be brought or consumed while on mission with us. Failure to adhere to this rule will result in immediate removal from the mission field.
“It is good not to eat meat or drink wine or do anything that causes your brother to stumble.” Romans 14:21 ESV

Confidentiality Agreement

By checking the box on the left, I agree to the following:
All information concerning clients, former clients, volunteers and financial data of CityServe, 180 Disaster Relief, and Spokes of Hope is confidential. “Confidential” means that you are free to talk about CityServe, 180 Disaster Relief, and Spokes of Hope and about a program and about your position, but you are NOT permitted to disclose clients’ names or talk about them on ways that will make their identity known. No information may be released without appropriate authorization. This is a basic component of client care and business ethics. The board of directors and our clients rely on volunteers to conform to this rule of confidentiality. CityServe, 180 Disaster Relief, and Spokes of Hope expects you to respect the privacy of clients and to maintain their personal information as confidential. Confidentiality is the preservation of privileged information. I have read CityServe, 180 Disaster Relief, and Spokes of Hope Confidentially Statement above. I understand that violations of this statement could lead up to termination of my volunteer services.

I ACKOWNLEDGE AND REPRESENT THAT I HAVE CAREFULLY READ THIS DOCUMENT AND FULLY UNDERSTAND ITS CONTENTS, THAT I SIGN IT VOLUNTARILY AS MY OWN FREE ACT AND DEED, AND THAT NO ORAL REPRESENTATIONS, STATEMENTS, OR INDUCEMENTS HAVE BEEN MADE BY ANY PARTY.

Digital Signature Agreement

By checking the box on the left, I agree and acknowledge my digital signature is legal and binding.

Signature

Date

National Volunteer Contact Form

Contact Information

COMPLETE THIS SECTION ONLY IF VOLUNTEER IS A MINOR:

Release, Waiver of Liability, and Indemnification Agreement