Volunteer Application
The following application must be completed thoroughly with the volunteer along with their parent or legal guardian. Minors should not continue the application process without supervision.
First Name *
Last Name *
Email *
Personal email address if you have one or parents email if not.
Date of Birth *
Address *
City *
State *
ZIP Code *
Phone *
Personal mobile or home phone
Grade *
School Attending *
Gender *
First & Last name of Parent/Legal Guardian *
Adult volunteers should list an emergency contact.
Email for Parent/Guardian *
This must be an email address that goes directly to you parent in case we need to directly contact them for emergencies or other purposes.
Phone Number of Parent/Guardian *
Home Phone
If different from numbers already listed
Relationship to Volunteer *
First & Last Name (Secondary Contact)
Who else can we get ahold of in an emergency?
Email (Secondary Contact)
Phone (Secondary Contact)
Relation to Volunteer (Secondary Contact)
Insurance Company *
Emergency Medical Information
Policy Number *
Emergency Medical Information
Medications *
Emergency Medical Information - These must be self administered. CMSEC staff are not permitted to administer medications.
Medical Conditions/Allergies *
Emergency Medical Information - Anything we need to be aware of so first responders can be well informed.
I have read through and understand all that is involved with being a volunteer contained in the document "How Do I Become a Volunteer." *
Volunteer Code of Conduct *
Information for the Volunteer Code of Conduct can be found at: https://drive.google.com/open?id=1cS2IOuZp_vFeZViprBc2p1m7K1pXavoXYbDChI4rT1k&authuser=0
Waiver of Liability *
In consideration of being permitted to participate in any way in activities, classes, simlabs, missions, and volunteering, I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue members of Alpine School District, its officers, employees, and agents from liability from any and all claims including the negligence of Alpine School District, its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in all activities and projects.
Assumption of Risks *
Participation in the Christa McAuliffe Space Center carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains; 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions; and 3) catastrophic injuries including paralysis and death. I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in Christa McAuliffe Space Center activities. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.
Indemnification and Hold Harmless *
I also agree to Indemnify and Hold Alpine School District HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney's fees brought as a result of my involvement in the Christa McAuliffe Space Center, and to reimburse them for any such expenses incurred.
Severability *
The undersigned further expressly agrees that the foregoing Waiver and Assumption of Risk Agreement is intended to be as broad and inclusive as is permitted by the law of the State of Utah and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
Acknowledgment of Understanding *
I have read this Waiver of Liability, Assumption of Risk and Indemnity Agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.
Photograph and Information Release *
I give Alpine School District unlimited permission to copyright and use, publish, and republish for purposes of advertising, public relations, trade, or any other lawful use, information about me and reproduction of my likeness (photographic or otherwise) and my voice. I hereby waive any right that I (and minor) may have to inspect or approve the copy and / or finished project or products that may be used in connection therewith or the use to which it may be applied.
Signature & Date *
By signature on the enrollment form, the parent/guardian of said minor consents and agrees, individually and as a parent or guardian of the minor, to the foregoing terms and provisions. By signing and dating this document, parent/legal guardian and youth certify that they have read, understand and agree to the terms of the Waiver of Liability, Assumption of Risk, and Indemnity Agreement Code of Conduct, and Photograph and Information Release; and, further, that they understand and give their informed consent to exceptions to the policy on youth members supervision, when, from time to time, it may be impractical or impossible for a minimum of two adults to be present with youth.
Digital Signature *
I understand that typing in my full name will be considered an electronic signature in place of being able to physically sign this document.
Signature of Participant *
Type volunteer's full name (E-Signature)
Signature of Parent/Legal Guardian *
Parent/Legal Guardian must type full name (E-Signature) if volunteer is a minor
Today's Date *
Age *
If participant is a minor
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