COVID-19 Volunteer Form
Thank you for your interest in assisting the City of Corcoran with COVID-19 related needs. We're currently only allowing volunteers ages 18 and older. Questions regarding this form or other COVID-19 volunteer related items can be directed to Emergency Operations Center Manager, Jessica Christensen Buck ( | (763) 400-7034).
First and Last Name *
Date of Birth (MM/DD/YYYY) *
Phone number *
Email *
Address (Street, City, State) *
What does your availability look like during an average week? (ei. Mondays and Wednesdays after 5 pm) *
Liability Release - I hereby release and hold the City of Corcoran harmless from any liability, claims, damages, costs, judgments, or expenses I may incur while participating in the activity or program. I understand that the activity or program is voluntary and may result in injury or damage to persons and/or property. By signing below I assume all risks and will adhere to the policies, rules, and guidelines provided, either written or otherwise stated, for the activity or program. Tennessen Warning - In accordance with the Minnesota Government Data Practices Act, the City of Corcoran informs you that the personal information we are requesting of you may be considered private. Private data is available to you and City staff and other personnel involved in the program that need to have this information for program administration, but will not be provided to the public. You may choose to withhold this information with consequences including, but not limited to, inability for the City to complete your registration and not receiving updated program information. By checking the box, I acknowledge that I have read and understood the contents of this notice and I agree to the terms contained herein. *
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