Cambiando Vidas Team Member Application
Thank you for your interest in Cambiando Vidas!!
All prospective Cambiando Vidas Team Members must complete the following application prior to being considered for a team build. Completion of the form does not guarantee a team member's place on a team. Team leaders will confirm a person's place on the team. Once confirmation is received from the Team leader, a deposit is required to hold that spot.
First Name
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Last Name
Your answer
Email Address
Your answer
Month and Year of the Build
Your answer
Team Leader or Group Name
Your answer
Home Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Country
Your answer
Cell Phone Number
Your answer
Date of Birth
Your answer
Health Insurance Company
Your answer
Health Insurance Policy Number
Your answer
Emergency Contact Name
Your answer
Emergency Contact Telephone
Your answer
Primary Language Spoken
Your answer
Secondary Language Spoken
Your answer
Previous Volunteer Experience
Your answer
Health Status
Please list any medical conditions in which you are currently under a physician's care.
Your answer
Please list any medications that you are currently taking.
Your answer
Please list any allergies that you have.
Your answer
Please advise if you are under a special diet.
Your answer
T-Shirt Size (sizes may be limited)
Waiver and Release:
I hereby freely and voluntarily, without duress, execute this Waiver Release under the following terms: I, the undersigned, by way of this internet-submitted form, release and hold harmless Cambiando Vidas and its successors from any liability, claims and demands of any nature that may arise from my work with the organization. I understand and acknowledge that this Release discharges Cambiando Vidas from any liability or claim that I may have against Cambiando Vidas regarding personal injury, illness, death or property damage that may result from my volunteering. Cambiando Vidas does not assume any responsibility or obligation to provide financial assistance in the event of injury, illness, death or property damage. Cambiando Vidas does not carry or maintain health, medical or disability insurance coverage for any volunteer. I release Cambiando Vidas from any claim of medical services rendered in connection with an emergency during my time with Cambiando Vidas.

ASSUMPTION OF RISK. The undersigned acknowledges that volunteering with Cambiando Vidas may include hazardous activities such as transport and use of heavy equipment and materials, use of local transportation, consuming local foods and water, experiencing local everyday hazards or local civil unrest. I assume the risk of any injury or harm in the course of volunteering, and release Cambiando Vidas from all liability.

PHOTOGRAPHIC RELEASE. I grant permission to Cambiando Vidas for any photographic images and / or video recordings made by Cambiando Vidas during my work with Cambiando Vidas. To express my understanding of this release, I submit the Release and Waiver Form, below. This Release and Waiver of Liability will be valid for one year from signed date.

Acknowledgment:
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