Section 1 of 2
VOLUNTEER FORM
VOLUNTEER FORM Please complete section 1 and 2 (Waivers)
Valid Email
Valid Email
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First Name
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State
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COUNTY
COUNTY
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T-Shirt Size (pick 1 size only)
T-Shirt Size (pick 1 size only)
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M
L
XL
XXL
XXXL
Thank You but I do not want a t-shirt
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Will you be available for the entire camp session? Click on Yes. If you can only stay part of the time, please select Other and include timeframe (ie: 9-11)
Will you be available for the entire camp session? Click on Yes. If you can only stay part of the time, please select Other and include timeframe (ie: 9-11)
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No
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Volunteer status
Volunteer status
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Student - Georgia State University OT Program
Student - name of school and program in Other
Health Care Professional - GSU OT Department
Individual volunteer
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Current Age (Request for grant funding)
Current Age (Request for grant funding)
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Date of Birth (Requested for grant funding-Not Required)
Date of Birth (Requested for grant funding-Not Required)
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Gender* (Requested for grant funding)
Gender* (Requested for grant funding)
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Female
Male
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Race (Requested for grant funding)
Race (Requested for grant funding)
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White/Caucasion
African American/Black
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Comments or NA
Comments or NA
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Section 2 of 2
Waivers
The following waivers must be read, dated and signed before BIAG’s Virtual Camp begins for campers,
caregivers, volunteers, staff
caregivers, volunteers, staff
LIABILITY RELEASE. For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I, as an individual (self), parent or legal guardian of the participant, hereby grant the permission necessary to allow individual participate in this virtual event, competition, training, class and/or camp ("Event") to be conducted by the Brain Injury Association of Georgia (BIAG). I, in my own behalf and/or on behalf of the individual, further agree to release and to hold Brain Injury Association of Georgia’s (BIAG) corporate sponsors (hereinafter “Sponsors”), the online platform through which the Event is being conducted (hereinafter the "Location"), the affiliates of Brain Injury Association of Georgia (BIAG), and the respective directors, officers, representatives, members, volunteers, agents and employee(s), a non for profit corporation of the preceding parties (hereinafter collectively “Releases”) from any and all liability, whether caused by the negligence of the Releases or otherwise for any claim, judgment, loss, liability, cost and expenses (including, without limitations, attorney's fees and costs) arising out of or connected with the Event, including any claim arising out of or connected with any illness or injury (minimal, serious, catastrophic and/or death) that may incur or sustain during the Event, all activities associated with the Event and while traveling to and from the location from which the individual is participating in the Event. I further expressly agree to indemnify and hold harmless Releases and Releases' heirs, successors, assigns, executors and administrators against loss from any further claims, demands or actions that may subsequently be brought by the individual or by any other persons on the account of damages of any character resulting to individual in any way from the foregoing activities. I further agree to reimburse and to make good to Releases any loss, or costs Releases may have to pay as a result of any such action, claim, or demand I, in my own behalf and on behalf of the individual, hereby warrant that I have read this Liability Release in its entirety and fully understand its contents. I, in my own behalf and on behalf of the individual, am aware that this Liability Release releases Releases from liability and contains an acknowledgement of my voluntary and knowing assumption of the risk of injury or illness. I, in my own behalf, further acknowledge that nothing in this Liability Release constitutes a guarantee that the Event will occur. I, in my own behalf and on behalf of the Participant have signed this document voluntarily and of my own free will. By joining or otherwise participating in our virtual programming, you are indicating that you have read, understand, and assume the risks and agreements of engaging in BIAG programs via remote platforms such as Zoom, and that you have read, understood and agreed to the terms of BIAG’s Statement of Informed Consent and Release of Risk and Liability Forms
LIABILITY RELEASE. For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I, as an individual (self), parent or legal guardian of the participant, hereby grant the permission necessary to allow individual participate in this virtual event, competition, training, class and/or camp ("Event") to be conducted by the Brain Injury Association of Georgia (BIAG). I, in my own behalf and/or on behalf of the individual, further agree to release and to hold Brain Injury Association of Georgia’s (BIAG) corporate sponsors (hereinafter “Sponsors”), the online platform through which the Event is being conducted (hereinafter the "Location"), the affiliates of Brain Injury Association of Georgia (BIAG), and the respective directors, officers, representatives, members, volunteers, agents and employee(s), a non for profit corporation of the preceding parties (hereinafter collectively “Releases”) from any and all liability, whether caused by the negligence of the Releases or otherwise for any claim, judgment, loss, liability, cost and expenses (including, without limitations, attorney's fees and costs) arising out of or connected with the Event, including any claim arising out of or connected with any illness or injury (minimal, serious, catastrophic and/or death) that may incur or sustain during the Event, all activities associated with the Event and while traveling to and from the location from which the individual is participating in the Event. I further expressly agree to indemnify and hold harmless Releases and Releases' heirs, successors, assigns, executors and administrators against loss from any further claims, demands or actions that may subsequently be brought by the individual or by any other persons on the account of damages of any character resulting to individual in any way from the foregoing activities. I further agree to reimburse and to make good to Releases any loss, or costs Releases may have to pay as a result of any such action, claim, or demand I, in my own behalf and on behalf of the individual, hereby warrant that I have read this Liability Release in its entirety and fully understand its contents. I, in my own behalf and on behalf of the individual, am aware that this Liability Release releases Releases from liability and contains an acknowledgement of my voluntary and knowing assumption of the risk of injury or illness. I, in my own behalf, further acknowledge that nothing in this Liability Release constitutes a guarantee that the Event will occur. I, in my own behalf and on behalf of the Participant have signed this document voluntarily and of my own free will. By joining or otherwise participating in our virtual programming, you are indicating that you have read, understand, and assume the risks and agreements of engaging in BIAG programs via remote platforms such as Zoom, and that you have read, understood and agreed to the terms of BIAG’s Statement of Informed Consent and Release of Risk and Liability Forms
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Camp BIAG Virtual Camp Consent and Authorization Consent to Participate in a Virtual Learning Environment. Waiver applies to: Camper, Caregiver, Volunteer, and Staff By enrolling in this virtual camp program (the “Program”), provided by the Brain Injury Association of Georgia, (the “BIAG”), I understand that my participation in the Program is voluntary and that as a condition of such participation, I agree to comply with all Program requirements including, but not limited to: (a) accurately completing all forms in a timely manner; (b) familiarizing myself with, or ensuring that I am aware of the Program’s standards of conduct for an online camp environment; and (c) immediately notifying the Camp Director (Marti Hanson) or Camp Administrator (Leslie Petsoff) of any concerns related to the health, safety or security of Camper, Caregiver, Volunteer or other participants, or Program staff. Video and Audio Recording I understand that camp sessions may be recorded for use by BIAG, including for those who are unable to attend live. I agree that if I participate in a virtual camp session (a) with a computer or mobile device camera engaged or (b) utilizing a profile image, then I hereby consent to have a video or image recorded. If I am unwilling to have my profile or video image recorded, I will ensure that my camera is disabled and that no profile image is used. Likewise, if I intend to un-mute my computer or mobile device during a virtual camp session and participate orally I hereby consent to have my voice recorded. If I am unwilling to have my voice recorded I will ensure that my computer or mobile device is muted and I will communicate exclusively using the "chat" feature. Consent for Use of Recordings - I understand the use of my camera and/or microphone during a virtual camp session is optional. However, by signifying my consent below, or by enabling the use of my camera and/or microphone during a virtual camp session, on behalf of myself and/or my camper, I hereby expressly grant permission to the BIAG to record and publish audio files, photographs, and video footage in which I will appear, and to use such recorded content for promotional purposes for as long as the BIAG desires. Furthermore, on behalf of myself or my Camper, Volunteer or Staff, I hereby waive any rights of compensation and ownership with respect to such recorded content, and I forever discharge and release the BIAG, including its employees, officers, agents, students, and other persons acting under its authority, from all claims and causes of action, liabilities, and damages arising out of the use of audio recordings, photographs, or video footage, including but not limited to claims for invasion of privacy or misrepresentation. I understand that through use of a camera and/or microphone during a virtual camp session, I will be offering my implied consent to the use of such recordings for this Program. 3rd Party Software I acknowledge that BIAG may utilize third party service providers to provide online resources that will be used as part of the Program and that such third party service providers may collect information from me. If I am the parent or legal guardian of a participating camper, I hereby approve their use of the listed software applications under the terms provided by the software application provider, and I agree to (a) create my own personal software application account or (b) download my own copy of the software application for such purposes. I agree to supervise use of any such software application to the extent appropriate. I further agree that the BIAG shall not be responsible nor liable for the performance of such software applications, nor for the actions of the software provider(s). SIGNATURES If I am a Program participant, by selecting Agree below I certify that I am 18 years of age or older, I have read the above permission and release terms, and I execute this consent and release form with full knowledge of its significance.
Camp BIAG Virtual Camp Consent and Authorization Consent to Participate in a Virtual Learning Environment. Waiver applies to: Camper, Caregiver, Volunteer, and Staff By enrolling in this virtual camp program (the “Program”), provided by the Brain Injury Association of Georgia, (the “BIAG”), I understand that my participation in the Program is voluntary and that as a condition of such participation, I agree to comply with all Program requirements including, but not limited to: (a) accurately completing all forms in a timely manner; (b) familiarizing myself with, or ensuring that I am aware of the Program’s standards of conduct for an online camp environment; and (c) immediately notifying the Camp Director (Marti Hanson) or Camp Administrator (Leslie Petsoff) of any concerns related to the health, safety or security of Camper, Caregiver, Volunteer or other participants, or Program staff. Video and Audio Recording I understand that camp sessions may be recorded for use by BIAG, including for those who are unable to attend live. I agree that if I participate in a virtual camp session (a) with a computer or mobile device camera engaged or (b) utilizing a profile image, then I hereby consent to have a video or image recorded. If I am unwilling to have my profile or video image recorded, I will ensure that my camera is disabled and that no profile image is used. Likewise, if I intend to un-mute my computer or mobile device during a virtual camp session and participate orally I hereby consent to have my voice recorded. If I am unwilling to have my voice recorded I will ensure that my computer or mobile device is muted and I will communicate exclusively using the "chat" feature. Consent for Use of Recordings - I understand the use of my camera and/or microphone during a virtual camp session is optional. However, by signifying my consent below, or by enabling the use of my camera and/or microphone during a virtual camp session, on behalf of myself and/or my camper, I hereby expressly grant permission to the BIAG to record and publish audio files, photographs, and video footage in which I will appear, and to use such recorded content for promotional purposes for as long as the BIAG desires. Furthermore, on behalf of myself or my Camper, Volunteer or Staff, I hereby waive any rights of compensation and ownership with respect to such recorded content, and I forever discharge and release the BIAG, including its employees, officers, agents, students, and other persons acting under its authority, from all claims and causes of action, liabilities, and damages arising out of the use of audio recordings, photographs, or video footage, including but not limited to claims for invasion of privacy or misrepresentation. I understand that through use of a camera and/or microphone during a virtual camp session, I will be offering my implied consent to the use of such recordings for this Program. 3rd Party Software I acknowledge that BIAG may utilize third party service providers to provide online resources that will be used as part of the Program and that such third party service providers may collect information from me. If I am the parent or legal guardian of a participating camper, I hereby approve their use of the listed software applications under the terms provided by the software application provider, and I agree to (a) create my own personal software application account or (b) download my own copy of the software application for such purposes. I agree to supervise use of any such software application to the extent appropriate. I further agree that the BIAG shall not be responsible nor liable for the performance of such software applications, nor for the actions of the software provider(s). SIGNATURES If I am a Program participant, by selecting Agree below I certify that I am 18 years of age or older, I have read the above permission and release terms, and I execute this consent and release form with full knowledge of its significance.
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