Minor Volunteer Release and Authorization to Treat Form
NO ONE WILL BE PERMITTED TO PARTICIPATE IN ANY HANDS ON
JACKSONVILLE ACTIVITY WITHOUT A SIGNED RELEASE FORM.
Minor Child's Name: ______________________________________________________________
I, the undersigned, wish to allow my minor child to volunteer his or her services to various community
service organizations and projects through, HandsOn Jacksonville, Inc. ("HOJ"), a charitable non-profit
Florida corporation. In consideration of HOJ locating, arranging, coordinating and/or making available
volunteer opportunities, I acknowledge, understand, and agree to the following:
 Description of Activities
I understand that the nature of the volunteer services which are typically performed by HOJ volunteers,
and which may be performed by my child as a HOJ volunteer, involve (a) physical activity (which may
include work with heavy tools and materials), (b) contact with unidentified and unfamiliar persons, (c)
travel to and from various unspecified locations, and (d) other activities involving potential risk of injury.
 Release from Liability
I agree to assume all risk associated with my child’s participation in HOJ activities. I release HandsOn
Jacksonville, Inc. from liability and covenant not to sue for any injury to my child’s person or property.
 Waiver of Claims.
I waive all claims for harm caused to my child against HandsOn Jacksonville involving my child’s
participation in any HOJ related activity. I understand that this waiver applies to HOJ, as well as its
directors, officer, partners, agents, employees, successors, assigns, licensees, sponsors, donors,
representatives, guests, affiliates, and other similarly situated persons.
 Use of Likeness
I give HandsOn Jacksonville, its assigns, and/or successors the right to use my child’s name, photograph,
likeness, image, voice, and biography in any media, including publications, advertising, and publicity, in
connection with my child’s participation. I agree that, should HOJ choose to use my child in any media,
HOJ need not compensate my child or me in any way.
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6817-1902 Southpoint Parkway · Jacksonville, FL 32216 · T 904.332.6767 · F 904.332.6722 ·