NA Clean Connections Volunteer Sign-Up
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Date *
MM
/
DD
/
YYYY
First Name/ Last Initial *
Clean Date *
MM
/
DD
/
YYYY
Age Range *
Gender Identity *
Languages Spoken *
Phone *
Email *
Address
City/Town *
Zip Code *
Part of Town *
Volunteer Participation Agreement
By signing my full name below, I understand that I am participating as a volunteer in NA Clean Connections and may provide transportation to individuals recently released from facilities. I acknowledge that this involves inherent risks, including potential exposure to unsafe, unpredictable, or harmful situations and interacting with individuals whose background, behavior, or intentions are unknown, as well as transporting passengers in my personal vehicle, and I voluntarily assume all such risks. I confirm that I am responsible for my vehicle, valid driver’s license, insurance, and compliance with all laws. I agree to follow program guidelines and leave any situation that feels unsafe, and if need be, contact law enforcement. To the fullest extent permitted by law, I release and hold harmless Narcotics Anonymous, the Greater Albuquerque Area Service Committee, the Public Relations Committee, and all affiliated members from any liability arising from my participation, except where prohibited by law. *
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