Gaining Ground Volunteer Release and Waiver of Liability

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To be filled out by:
Group or Family Leader, representing any accompanying adults and/or minors, OR
Individuals age 15 and older, volunteering on their own

Email *

Volunteer Date *

YYYY

Session Start Time *

First Name *

Last Name *

Name of Organization or Group, if applicable

Number of Adults Volunteering (Ages 18 +) *

Number of Young Adults (15-17 years old) *

Number of Children (ages 5 - 14) *

Check if accompanying minors:

I am accompanying minors and assume full responsibility for their participation and behavior.

Address (Street or P.O. Box) *

City *

State *

Postal Code *

Country

Phone Number *

Emergency Contact Name (First, Last) *

Emergency Contact's Phone Number *

Volunteer Release Statement *

While working at Gaining Ground there are inherent risks. Every reasonable effort will be made to emphasize safe working habits. I understand and accept these risks and will hold Gaining Ground and the Town of Concord harmless for any and all injuries or illness suffered in the course of volunteering. In this activity it is impossible to completely eliminate the risk of becoming exposed to and/or infected by COVID-19. As outlined by the CDC, older adults and those of any age with serious underlying health conditions may be at higher risk for severe illness from COVID-19. I agree to abide by health and safety protocols established for the activity in order to minimize risk.

I agree to the terms above.

Photo Release Statement *

A group leader or I may explicitly request photos not be taken of members of the group when physically on site volunteering. Otherwise, I give permission for Gaining Ground to photograph me and/or members of my volunteer group for appropriate promotional purposes.

Yes, I give permission for Gaining Ground to photograph me and/or members of my group.

No, I do not give permission for Gaining Ground to photograph me and/or members of my group.

Digital Signature (Full, Legal Name) *

By entering your name below, you are signing this electronic waiver form and agreeing to the terms and conditions stated herein.

Send me a copy of my responses.

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