LEADERSHIP SOUTHWEST CLASS 2024 COMMUNITY PROJECT REGISTRATION FORM
Dear Volunteer,
 
Thank you for volunteering your amazing generosity, talents and dedication and partnering with the Leadership Southwest Class of 2024, and the Cynthia Mickens Ministries, Inc., to help build and beautify the PATH Community Garden and Gardening Place that will be done on September 21st, 2024!
  • Please take a few minutes and complete the registration form below. Once you register, you will be contacted by a member of the LSW 2024 Registration Team to confirm your volunteer selection and preferred volunteer time. 
  • Once your volunteer selection and preferred volunteer time has been confirmed, you will be provided a Know Before You Go information sheet to assist with more details about the event, what to expect before event and the day of the event!

Thank you for making a difference in our community! 

PLEASE NOTE: 
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Are you a LSW Class of 2024 member? *
First Name *
Last Name *
Phone Number *
Email *
Organization *
Please provide your T-Shirt Size
Parent/Guardian Name, Email and Phone Number for Minors Only
Are you interested in volunteering for CONSTRUCTION LIFTING & TRANSPORT (Individuals who can help transport construction materials such as lumber, soil, etc., to the construction site.) *
Required

If you are Interested in volunteering for CONSTRUCTION OF GARDEN BEDS, please select all that apply:
 *
Required

If you are Interested in volunteering for CONSTRUCTION OF GAZEBO, please select all that apply:
 *
Required

If you are Interested in volunteering for GENERAL VOLUNTEER DUTIES, please select all that apply:
 *
Required
Please select the time(s) you are available to volunteer on SATURDAY, SEPTEMBER 21, 2024. You may choose more than one timeframe.
 *
Required

**LIABILITY AND INDEMNITY CLAUSE**
By volunteering for this event,  I agree to release and hold harmless Leadership Southwest, Inc., and Cynthia Mickens Ministries, Inc., its trustees, officers, agents, employees and volunteers, from any and all liability, actions, causes of action, negligence, debts, claims, or demands of any kind and nature whatsoever including, but not limited to, claims for negligence, recklessness or any other form of action for which a release may be legally given (including attorneys’ fees and costs) which may arise by or in connection with my participation in this event. I agree further to hold harmless and indemnify  Leadership Southwest, Inc., and Cynthia Mickens Ministries, Inc., its trustees, officers, agents, employees and volunteers from any and all liability, actions, causes of action, negligence, debts, claims or demands of any kind and nature whatsoever (including attorneys’ fees and costs) by any person or  Leadership Southwest, Inc., and Cynthia Mickens Ministries, Inc., which may arise by or in connection with my participation in the event.
 *
**LIABILITY AND INDEMNITY CLAUSE FOR MINORS** (Must be Agreed/Disagreed by Parent/Guardian of Minor Aged Volunteers)

By volunteering for this event,
I acknowledge that any minors in attendance must be supervised at all times. I understand and agree that it is my responsibility to ensure the proper supervision of any minors for whom I am responsible during the event. I agree to release and hold harmless Leadership Southwest, Inc., and Cynthia Mickens Ministries, Inc., along with their trustees, officers, agents, employees, and volunteers, from any and all liability, actions, causes of action, negligence, debts, claims, or demands of any kind, including but not limited to claims for negligence or recklessness (including attorneys’ fees and costs) that may arise from my participation in this event. 
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**LIABILITY AND INDEMNITY CLAUSE FOR PHOTOGRAPHY** (Must be Agreed/Disagreed by all Volunteers)

By volunteering for this event,
I grant permission for photographs taken during the event to be used in social media or other promotional materials by Leadership Southwest, Inc., and Cynthia Mickens Ministries, Inc. I further agree to indemnify and hold harmless Leadership Southwest, Inc., and Cynthia Mickens Ministries, Inc., their trustees, officers, agents, employees, and volunteers from any and all liabilities, actions, causes of action, negligence, debts, claims, or demands of any kind (including attorneys’ fees and costs) that may be made by any person or entity arising from my or a minor's participation in the event.
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