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 email address *
Street Address *
City, Zip Code *
Phone Number *
Interests *
Single Paragraph Autobiography *
Sample Offer *
Sample Request *
Reference One: Name *
Reference One: Email Address *
Reference One: Phone Number *
Reference One: Relationship *
Reference One: How Long Known *
Reference Two: Name *
Reference Two: Email Address *
Reference Two: Phone Number *
Reference Two: Relationship *
Reference Two: How Long Known *
Background Disclosure: Are you currently on parole? Have you been convicted of a felony? *
Release of Liability: initial each of the following five Agreements. Agreement 1: I have read and understood the Handbook *
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. *
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. *
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 TimeBank exchanges. *
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. *
I certify all the above information is correct. *
Clear selection
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 - Privacy Policy