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Yes both
Phone number only
Email only
No neither
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1.
I Agree for myself (Adult)
2.
I Agree for myself and minor child/children
3.
I Agree for my minor child/children sent with a Designated Responsible Adult (Please be sure to list child children as well as the DRA) in the appropriate lines below
4.
We agree as a married couple (Husband & Wife)
5.
We agree as a married couple (Husband & Wife) & minor child/children. (Please List ALL names in the appropriate lines)
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Saturday, April 16th
Saturday, May 21st
Saturday, June 18th
Saturday, July 16th
Saturday, August 20th
Saturday, September 17th
Saturday, October 15th
Saturday, November 19th
Saturday, December 17th
Saturday, March 19th, 2022
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Yes, I will arrive at 10:30am and stay until 3pm
I will arrive at 10:30am but I must leave before 3pm (Please enter leave time in other)
I will arrive after 10:30am, but I will stay until 3pm (Please enter arrival time in other)
I will arrive after 10:30 am and must leave before 3pm (Please enter arrival & departure time in other)
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Yes
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No
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Adult Participant(s) Name(s)
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Phone number
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Permission to add your number/email to our volunteer database.
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Participant(s) acknowledge that they are voluntarily participating in a charitable event/service to serve people experiencing homelessness and others in need sponsored/partnered by Service Without Walls, Inc.                                                              Participants also acknowledge that such events may take place in areas within the city limits of Atlanta and/or in other challenged neighborhoods and that such voluntary participation has the potential risk of being exposed to criminal activity which may result in the loss of property of or personal injury to the Participant(s).                                                        Participant(s) acknowledge that there is a continuing Pandemic (COVID-19) in addition to other diseases that can be communicated or transmitted in group settings. Participants agree to wear masks, socially distance and follow CDC guidelines while participating in/with Service Without Walls sponsored/partnered charitable events/services.                                                               Participant(s) fully assume(s) the risks associated with the participation in the event(s) by being present and/or participation in these events.                                                                        In addition, volunteers, servers and/or participants do hereby agree to hold harmless, not file suit and promise to indemnify, Service Without Walls, Inc., its officers, directors, owners and/or agents from any and all claims, demands, causes of action and other liabilities that may arise while: serving, visiting, participating, in route to or from a sponsored/partner event.                       Participation and presence at our sponsored/partner events also indicates your approval for you and any minor(s)/dependent(s) to be pictured in video, photographs and likeness by Service Without Walls, Inc. and may be used on promotional and/or other materials, websites and/or social media sites as allowed by Service Without Walls.                                                                   This agreement will remain in effect from the date signed/submitted for every time you volunteer/participate until revoked in writing. You may be asked to submit or sign a new agreement each year or when changes are made.
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Name(s) Minor Children ***Enter DNA if it Does Not Apply***
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Name(s) of Designated Responsible Adult(s) if parent/legal guardian will not be present. (DRA Must be over 18 AND at least 6 years older than child)* (must be completed by parent or legal guardian only) *Both MUST Sign in signature area* ***Enter DNA if it Does Not Apply***
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Name of Parent/Legal Guardian assigning the above Designated Responsible Adult (Print) **Required if there is an assigned Designated Responsible Adult** ***Enter DNA if it Does Not Apply***
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I would like to sign up to serve the following Saturday(s)                               If it is within 48 hours of a date you would like to attend please call 770-954-5378 after submitting your Waiver/Request.
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If you sign up to serve please arrive by 10:30am and plan to stay until 3pm (or until packed up...after 2pm) If you know you will not be able to arrive by 10:30 or stay until 3pm. Please also select other and input the times you are able to serve on your choice of date/time.
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If you are unable to serve on a day you requested and are signed up to serve; you will provide notice to allow others to serve and so that we are short-handed in servers.
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Submitting this form represents your legal agreement to these terms and conditions and you agree that your responses are true and correct. Please type name in other area
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Please Type Name Here representing your digital signature.
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