NLC Volunteer Participation and Family Waiver and Release Form

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NLC Volunteer Participation and Family Waiver and Release Form - Contra Costa Science Workshop

New Leaf Collaborative (NLC) is a California Nonprofit Public Benefit Corporation whose mission is to provide hands-on, experiential learning and leadership opportunities, in science, nature and ecological literacy in order to nurture the curiosity & well being of TK-14 students and community partners. NLC does this through several programs in and out of schools throughout Contra Costa County: Community Science Workshops, Community Garden Workshops and our Earth Ambassadors Program.

We are excited to offer high school student volunteer opportunities to help out at our Contra Costa Science Workshop (CCSW) Open Saturday. Our next event will be held on Saturday, 2/22/25 from 10 - 1 at the CCSW located at the Boys & Girls Martinez Clubhouse. See the flyer HERE. In order to be eligible to participate and earn volunteer hours, please have your parent or guardian complete this form prior to 2/22/25. Please plan on arriving at 9:45 and leaving after clean-up. Bring any school volunteer verification forms with you.

Please direct any questions or concerns to info@newleafcollaborative.org

Email *

Participant (Minor) First and Last Name *

Participant (Minor) Phone Number and/or Personal Email for reminders or schedule change notices. *

If you have given us a cell number, is text okay?

Yes

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THE FOLLOWING SECTIONS ARE FOR PARENTS/GUARDIANS:

DECLARATION OF LEGAL CUSTODY – I certify that I have legal custody of and responsibility for my child who is participating in the New Leaf Collaborative (“NLC”) activity listed above. I further certify that – if I have joint custody of this minor – I have notified the other parent or responsible party of his/her participation in the program.

Acknowledgement of Declaration of Legal Custody

Required

Parent/Guardian Full Name *

Parent/Guardian Phone Number *

PARENTAL/GUARDIAN CONSENT FOR PARTICIPANT WAIVER AND RELEASE - I give my consent for my child, named at the top of this application, to provide volunteer services to New Leaf Collaborative.

I understand and acknowledge that volunteering poses risks to my child. I (we), as parent(s) or guardian(s) of the minor, do hereby, for my child, myself, my heirs, executors and administrators, release and forever discharge New Leaf Collaborative and all officers, directors, employees, agents and volunteers of the organization, acting officially or otherwise, from any and all claims, demands, actions or causes of action which in any way arise from the minor’s participation in and travel to and from the above noted New Leaf Collaborative Program opportunity.

I hereby certify that the minor is my child and that his/her/their date of birth is listed below
and I do hereby certify that to the best of my knowledge and belief said minor is in good health. In case of illness or accident, permission is granted for emergency treatment to be administered. It is further understood that the undersigned will assume full responsibility for any such action, including payment of costs.

Parent/Guardian consent to PARTICIPANT WAIVER AND RELEASE

Required

ENTER MINOR'S DATE OF BIRTH
*

YYYY

I hereby advise that the above named minor has the following allergies, medicine reactions or physical conditions, which should be made known to a treating physician: (If none, please write the word “none”.):
*

In lieu of collecting your wet signature, by clicking the box you are electronically signing the document declaring legal custody & responsibility for your child who is participating the NLC activity. *

Parent/Guardian acknowledges receipt of the above information and consents to Declaration of Legal Custody and Participant Waiver and Release and certifies that the information indicated on this form is true.

Required

PERMISSION TO PHOTOGRAPH/VIDEO – New Leaf Collaborative is a nonprofit organization. Occasionally, program activities may be photographed or videotaped for educational, publicity, training or fundraising purposes. Please indicate if you will allow your child to appear in videos or photos without compensation (e.g., as part of brochures, slide shows, social media and/or program websites).

Yes, I give my permission.

No, my child may not appear in a photograph or videotape.

Required

A copy of your responses will be emailed to the address you provided.

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