TimeBank Santa Cruz Application
PERSONAL INFORMATION
The application information we request is for enrollment purposes and will not be disclosed. Only your name, phone number and email address will be available to others on our members-only website. Be sure to read the Handbook before applying. Please give us the best phone number to reach you and check your spam folder for response messages from us.

Please read the Handbook before filling out this Application: https://timebanksantacruz.org/handbook


First and Last Name: *
Your answer
Your email address *
Your answer
Street Address *
Your answer
City, Zip Code *
Your answer
Phone Number *
Your answer
Interests *
Your answer
Single Paragraph Autobiography *
Your answer
Sample Offer *
Your answer
Sample Request *
Your answer
Reference One: Name *
Your answer
Reference One: Email Address *
Your answer
Reference One: Phone Number *
Your answer
Reference One: Relationship *
Your answer
Reference One: How Long Known *
Your answer
Reference Two: Name *
Your answer
Reference Two: Email Address *
Your answer
Reference Two: Phone Number *
Your answer
Reference Two: Relationship *
Your answer
Reference Two: How Long Known *
Your answer
Background Disclosure: Are you currently on parole? Have you been convicted of a felony? *
Your answer
Release of Liability: initial each of the following five Agreements. Agreement 1: I have read and understood the Handbook *
Your answer
Agreement 2: I understand that TimeBank Santa Cruz shall have neither liability nor responsibility to any person or entity with respect to loss, damage, or injury caused or alleged to be caused directly or indirectly by information contained on this website or any other TimeBank resources. *
Your answer
Agreement 3: Since any agreements shall be made by and between parties involved in TimeBank exchanges, TimeBank Santa Cruz will not be held responsible and will not assume any liability for claims, damages, or any other consequences which may arise from this arrangement. *
Your answer
Agreement 4: I hereby agree the duty, responsibility, and liability that is inherent with TimeBank Santa Cruz exchanges shall remain as it would be if the parties were not part of any TimeBank. I agree to leave intact the normal remedies and cause-of-action available to these parties in the event of any unforeseen circumstance. I agree to indemnify and hold harmless all parties who facilitate or participate in TimeBank exchanges. *
Your answer
Agreement 5: I understand that TimeBank Santa Cruz does not check driving records; therefore, it is the responsibility of each member to screen drivers. Anyone who provides driving services is expected to have a valid driver’s license, carry auto insurance, use seat belts, follow driving laws, and maintain his/her car to a standard of safety. Be prepared to show your Driver's License and proof of insurance when they are requested. If requesting transportation, be sure to ask to see those documents before the Exchange begins. My signature on this Application is proof that I have read the Handbook and agree to abide by these five subsequent Legal Agreements. *
Your answer
I certify all the above information is correct. *
Your answer
Date *
MM
/
DD
/
YYYY
Submit your Application. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service