August 2022: One Small House Volunteer Form
Please complete the following registration questionnaire.

Trip Dates: August 1-5 2022
Trip Location: Tijuana, Mexico
Trip Leader: Dave Kinnoin and Craig Torres-Ness

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First Name: *
Last Name: *
Date of Birth: *
MM/DD/YYYY
Age *
Male or Female: *
Mailing Address (line 1): *
Street or PO
Mailing Address (line 2):
Additional address line
City: *
State/Province: *
Please use postal abreviations
Postal Code: *
Country; *
Email Address: *
Cell Phone Number: *
Emergency Contact: *
First and Last Name
Relationship to Emergency Contact:
Spouse, sister, brother, friend, etc.
Emergency Contact Phone Number *
Best number to reach
Please describe any medical or physical conditions we should know about to ensure that you stay healthy and safe during your trip: *
If none, please enter "none".
Did you receive COVID-19 vaccine?
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If so, which one and when?
ACKNOWLEDGEMENT AND ASSUMPTION OF RISK AND RELEASE AGREEMENT
PLEASE READ THIS ENTIRE DOCUMENT (hereafter ‘Document’) CAREFULLY BEFORE INDICATING THAT YOU AGREE. All participants must agree to this Document. For participants under 18 yrs. of age (hereafter sometimes ‘minor’ or ‘child’), parent/s or legal guardian/s (hereafter collectively ‘parent/s’) must also agree. In consideration of the services of One Small House, Inc., a not-for-profit corporation organized and existing under the laws of New York state, and all of its officers, directors, employees, representatives, agents, independent contractors, volunteers (including leaders and co-leaders), members and all other persons or entities associated with it (collectively referred to in this Document as ‘OSH’), I (participant and parent/s of a minor participant) acknowledge and agree as follows:
OSH volunteer-led charitable construction activities, may include, but are not limited to: construction, climbing ladders, use of dangerous tools and equipment, exposure to harmful or dangerous materials, travel outside the United States of America, food preparation, dining in unfamiliar facilities, or the use of facilities and transportation or travel to and from activities (referred to in this Document as ‘activities’ or ‘these activities’). The leaders of these activities are volunteers. They are not paid professional construction trades people or leaders. In all activities, all participants share in the responsibility for their own safety and the safety of the group. Participants (and parent/s of minors) take responsibility for having appropriate skills, physical conditioning, equipment and supplies for these activities.
These activities include inherent and other risks, hazards and dangers (referred to in this Document as ‘risks’) that can cause or lead to injury, property damage, illness, mental or emotional trauma, paralysis, disability or death to participant or others. Some, but not all of these risks include: hazardous and unpredictable ground, water or weather conditions; misjudgments made by leaders, co-leaders, participants or others; travel in remote areas that can cause potential delays or difficulties with transportation, evacuation and medical care; equipment that can fail or malfunction; the potential that the participant or others (e.g. co-participant, driver, medical and rescue personnel) may act carelessly or recklessly. I understand that OSH staff, leaders or other personnel cannot assure participant’s safety or eliminate any of these risks. Participant is voluntarily participating with knowledge of the risks. Therefore, participant (and parent/s of minors) assume and accept full responsibility for the inherent and other risks (both known and unknown) of these activities, and for any injury, damage, death or other loss suffered by participant, resulting from those risks, and/or resulting from participant’s negligence or other misconduct.
I (adult participant, and/or parent/s for themselves and for and on behalf of their participating minor child) agree to release and not to sue OSH (as OSH is defined above) in regard to any and all claims, liabilities, suits or expenses (including reasonable costs and attorneys’ fees) (hereafter collectively ‘claim’ or ‘claim/s’), including claim/s resulting from OSH’s negligence (but not its gross negligence or intentional or reckless misconduct), for any injury, damage, death or other loss to me or my child, in any way connected with my or my child’s enrollment or participation in these activities, or my use of OSH equipment, facilities or premises. I understand and agree here to waive all claim/s I or my child may have against OSH, and agree that neither I, my child, or anyone acting on my or my child’s behalf, will make a claim against OSH.
I (participant and parent/s of a minor participant) agree that the substantive laws of New York State govern this document and all other aspects of my relationship with OSH, and that any mediation, suit, or other proceeding must be filed or entered into only in New York state. This Document is intended to be interpreted and enforced to the fullest extent allowed by law. Any portion of this Document deemed unlawful or unenforceable shall not affect the remaining provisions, and those remaining provisions shall continue in full force and effect.
I (participant and parent/s of a minor participant) understand that during the activities I may be photographed or videotaped. To the fullest extent allowed by law, I waive all rights of publicity or privacy or pre-approval that I have for any such likeness of me or use of my name in connection with such likeness, and I grant OSH and its assigns permission to copyright, use, and publish (including by electronic means) such likeness of me, whether in whole or in part, in any form, without restrictions, and for any purpose.
PARTICIPANT AND PARENT/S OF A MINOR PARTICIPANT AGREE: I HAVE CAREFULLY READ, UNDERSTAND AND VOLUNTARILY AGREE TO THIS DOCUMENT AND ACKNOWLEDGE THAT IT SHALL BE EFFECTIVE AND BINDING UPON ME, MY MINOR CHILDREN AND OTHER FAMILY MEMBERS, AND MY HEIRS, EXECUTORS, REPRESENTATIVES AND ESTATE. Parent/s must agree below, both in their capacity as a participant, and as Parent/s of any  minor child identified below.
Do you agree to the above assumption of risk and release ? *
 In the event you have additional questions or concerns before you can complete this agreement and release, please close this registration page and use the "Contact Us" link on the One Small House web site so that we may follow up with your questions or concerns.  Thank you.
By checking the box below, I agree to allow One Small House to share the information I am submitting within this form with One Small House staff and the relevant teams leader(s).
Yes, I agree (Limited sharing of this information is necessary for the program.) *
Required
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