Volunteer Application Name: First Last Address: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone:Cell Phone:Understanding that the Filling Station primarily uses electronic communication, my preferred method of contact: (mark one) Email Text Phone Employer (if applicable:) Date of Birth: MM slash DD slash YYYY Gender: Race: Do you have skills, special interests or experience that you would like us to consider?Physical limitations:Please describe.Emergency contact:Name: First Last Phone:Cell:Relationship: Email: Liability Release: As a volunteer of Filling Station, I agree to abide by all policies and procedures as spelled out in the volunteer handbook and other organizational documents. I understand that I volunteer at my own risk and neither the organization nor its employees assume any liability for any accidental injury or health problem arising from volunteer work I perform for the organization. I agree that all work I do is on a volunteer basis and I am not eligible to receive any monetary payment or reward. I hereby grant permission to the Filling Station, their legal representatives and assigns, those for whom the Filling Station is acting, and those acting with their authority copyright and use, re-use, and publish, and re-publish photographic portraits or pictures, television/video, web and radio/audio recordings of me without further consideration, and I acknowledge that the Filling Station may crop or treat the photographs at its discretion. I hereby waive any right that I may have to inspect or approve the finished product or products or the advertising copy, printed or recorded. Consent for Adult Applicant I hereby warrant that I am age 18 or older and have every right to contract in my own name in the above regard. I state further that I have read the above authorization, release and agreement, prior to its execution, and that I am fully familiar with the contents thereof.Consent of Adult for Minor Applicant I hereby warrant that I am the parent or guardian of the above-named applicant and have every right to sign on his/her behalf in the above regard. I state further that I have read the above authorization, release and agreement, prior to its execution, and that I am fully familiar with the contents thereof and have reviewed them with the applicant.Applicant (age 18 and older):Signature:Date: MM slash DD slash YYYY Signing on behalf of applicant under age 18:Name: First Last Relationship: Signature:Date: MM slash DD slash YYYY Δ
