MLK Day of Service Volunteer Registration
This MLK Day think of the most vulnerable in our community!
Volunteer to assemble and deliver fresh produce packages to home bound seniors.

On January 17th, 2021 at the Shorefront Y 3300 Coney Island Ave
Schedule of the day:
10-10:30 AM Volunteer check-in
10:30-12 Volunteers will prepare personal messages and pack bags to prepare for deliveries
12-12:30 lunch
12:30-3PM Volunteers will deliver care packages to home-bound seniors


Families with children are welcome! Children under the age of 14 must be accompanies by an adult.

If you have any questions don't hesitate to reach out!

Dorf
Jonathan “Dorf” Dorfberger
Director of Day Camp and Teen Services
dorfj@shorefronty.org 
347-689-1815

Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Age *
If you are under the age of 18 and plan to attend this event unaccompanied by a parent/guardian, please share this link: https://forms.gle/kAkdx4XsVfhkthNm8 with your parent/guardian to grant you permission to participate.
Phone number *
What shift would you like to attend? *
If you are registering on behalf of a family, how many of your family members (including yourself) are planning to attend?
How did you hear about this event? *
Required
I understand that participation in the Shorefront YM-YWHA’s MLK Day of Service may contain risk, including, but not limited to, risks related to the coronavirus. I agree to comply with six foot social/physical distancing, and I understand that I am required to wear a mask. I also agree not to attend if I am feeling sick, have a temperature of 100 or above, or am aware that I’ve been exposed within the past 14 days to someone who is or became positive for coronavirus. *
Required
Agreement for Limited COVID-19 Release
As you are aware, the COVID-19 pandemic has resulted in a national state of emergency. During the crisis, Shorefront YM-YWHA is taking extra precautions to address the direct threat of COVID-19 to our program participants, visitors and employees. Some special activities to protect everyone include:•Performing extra cleanings of the facility, including workstations, restrooms, waiting areas, equipment and supplies;
•Requiring PPE, including face coverings or face masks for program participants, visitors and employees•Upgraded HVAC ventilation filters to MERV 11 (the highest level of filtration that our equipment can use)•Requiring employees to regularly hand wash;
•Requiring social distancing when possible;
•Providing wipes and sanitizer throughout the facility.
•Deeply clean and sanitize the facility at the close of all programming.
Even with our enhanced and ongoing safety precautions, we cannot guarantee that they will protect everyone from COVID 19.  

Due to the nature of our work and the uncertainty of the spread and contagion of COVID-19, the Shorefront YM-YWHA is requiring that each all program participants and guest agree to and sign this limited COVID-19 waiver and release for themselves and their children in programming.

Agreement for Limited COVID-19 Release
1. I am aware that there are risks associated with me and/or my child contracting COVID-19 by entering the Shorefront YM-YWHA facility or receiving services from the Shorefront YM-YWHA during the COVID-19 pandemic associated with entering the facility and/or being in contact with our employees and the facility during the COVID-19 pandemic.
2. On behalf of myself and/or my child, I knowingly assume all possible COVID-19 exposure risks, both known and unknown, relating to my presence in the facility or receiving services from organization
3. I hereby forever release, waive, relinquish, and discharge the Shorefront YM-YWHA, along with its owners, officers, directors, managers, employees, agents, insurance carriers or other representatives, and their successors and assigns (collectively, the “Shorefront YM-YWHA Representatives”), from any and all claims, demands, liabilities, rights, damages, expenses, and causes of action of whatever kind or nature, and other losses of any kind, whether known or unknown, foreseen or unforeseen, in any way related to the COVID-19 pandemic, (collectively, “Damages”) as a result of me and/or my child being a program participant, visitor or guest of the organization or receiving services from the Shorefront YM-YWHA, all limited to claims based on the alleged exposure to the COVID-19 virus because of any actions or inactions of any Shorefront YM-YWHA Representative. I further promise not to sue or bring any claims against the Shorefront YM-YWHA, based upon any alleged exposure to COVID-19 during any Shorefront YM-YWHA visit.

READ CAREFULLY --BY SIGNING THIS DOCUMENT YOU MAY GIVE UP IMPORTANT LEGAL RIGHTS
E-SIGNATURE: By entering your name below you agree to the above statements *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report