Looking for a Accident Waiver And Release Of Liability Form Templates? Download it for free!

Minor Release Form And Waiver Of Liability Form - Habitat For Humanity Of Council Bluffs Page 2

IN WITNESS WHEREOF, we have executed the Release as of the day and year first written above.

Volunteer Name: ________________________________________________________________________

Volunteer Current Address: _________________________ City _______________Zip Code __________

Volunteer Current Phone number: __________________________________________________________

Volunteer Current E-mail: ________________________________________________________________

Volunteer Signature: _____________________________________________________________________

Parent/Guardian Signature: _______________________________________________________________

Witness Signature: ______________________________________________________________________

EMERGENCY CONTACT INFORMATION

Contact: _______________________________________________________________________________

Relationship: ___________________________________________________________________________

Phone: ________________________________________________________________________________

MEDICAL CONDITIONS/MEDICATIONS

PLEASE INDICATE ANY MEDICAL CONDITIONS THAT YOU FEEL HABITAT FOR HUMANITY SHOULD

BE INFORMED OF or ANY MEDICATION YOU MAY NEED TO TAKE DURING YOUR TIME ON SITE:

(i.e. do you carry and require an epi-pen or do you carry and require insulin? Etc.)

______________________________________________________________________________________

Habitat for Humanity of Council Bluffs / 645 9th Ave. / Council Bluffs, IA 51501 / Phone: (712) 328-9476

Minor Release Form And Waiver Of Liability Form - Habitat For Humanity Of Council Bluffs Page 2