Volunteer Registration Form
Completing this form helps us match your interests with our staff and kids.
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Email *
First and Last Name *
Address (Mailing Address, City, State Zip) *
Mobile Phone Number *
Date of Birth *
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Your Age (if under 18 a parent must attend with you) *
Gender *
Emergency Contact Person & Number *
Do you have any allergies (food, environmental, seasonal, etc)? *
If Yes, describe all relevant allergies below. Please also list any special food/dietary needs or restrictions.
Which Fundango location(s) are you able to volunteer at? (Please select all that apply) *
Required
Which age groups would you most enjoy helping with? *
Required
How can we best use your skills/experience while volunteering with Kids at Heart? (i.e., art, musical interest/skills, culinary/cooking, etc.). *
Required
How did you hear about Kids at Heart? *
Would you like to join our volunteer email list for notice about upcoming volunteering opportunities? (You can also sign up directly at https://www.kidsatheartco.org/sign-up/).
 *
VOLUNTEER WAIVER OF LIABILITY
Confidentiality: I understand the information and records available to me through my position as a volunteer are strictly CONFIDENTIAL.  All information relating to the children and their parents will not be shared or used in any manner or for any purpose outside of Kids at Heart activities. I agree to preserve the confidentiality of any such information and I will not disclose such information to anyone other than Kids at Heart staff without a release of information request form signed by both the parents and Kids at Heart executive director, or by court order.  I agree to share any child protection concerns with the Kids at Heart executive director. *
Required
Functions and Activities: I understand that volunteering for the programs and recreational activities of Kids at Heart at any activity location is a privilege.  Prior to my participation in such activities, I acknowledge that there are certain risks associated with the activities, including by way of example but not limited to, physical injury due to activity related accidents, physical injury due to transportation related accidents, illness, or even death.  In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware. *
Required
Release of Liability - By signing this Permission/Waiver Form, I expressly warrant that the children under my parent/guardianship are capable of withstanding both the physical and mental demands of the activities discussed above. I also expressly assume all risks of the children or me participating in the activities, whether such risks are known or unknown to me at this time. I further release Kids at Heart and its leaders, employees, volunteers, and agents from any claim that my children may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities. This release of liability shall include (without limitation) any claims of negligence or breach of warranty. This release of liability is also intended to cover all claims that members of the child's or my family or estate, heirs, representatives, or assigns may have against Kids at Heart or its leaders, employees, volunteers, or agents. I further agree to indemnify and hold harmless Kids at Heart and its leaders, employees, volunteers, or agents from any and all claims arising from my participation in its activities and programs, or as a result of injury or illness of my children during such activities. *
Required
First Aid and Medical Treatment: I recognize there may be occasions where I may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health related condition or injury.  I do hereby give my permission for agents of Kids at Heart to seek medical attention or treatment for me, including hospitalization, if in the agent’s opinion, such need arises.  I agree to pay all fees and costs arising from this action to obtain medical treatment.  I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery, and I agree to pay for such medical treatment. *
Required
Signature (type your name) *
Date of signature *
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KIDS AT HEART VOLUNTEER REGISTRATION FORM
Revised 01/2023.
A copy of your responses will be emailed to the address you provided.
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