Individual Volunteer Form 2024

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Thank you for your willingness to volunteer with Hosanna Industries. In order for us to best provide for you we need to gather some information regarding, safety, lodging accommodations (if applicable), contact data and more.

This form is critical to better serve you as a volunteer and to better serve those in need.

Contact Becky Hetzer with any questions or concerns

rjhetzer@gmail.com or at (724)822-7862

First Name *

Last Name *

Address *

Phone Number *

Email *

Age

First time volunteering?

Yes

Clear selection

Which Volunteer Group do you belong to?

(if not with a group write N/A)

Start Date of Volunteering (if applicable)

YYYY

End Date of Volunteering (if applicable)

YYYY

Are you staying in the Austin Lodge (overnight)?

Yes

Clear selection

Emergency Contact Name *

Emergency Contact Phone Number *

Who is your insurance carrier? *

What is your insurance policy #? *

Date of last tetanus shot?

YYYY

Any medical concerns both physical and mental, that our team should be made aware of? Please list all that apply and any details you can provide are helpful.

Safety & accessibility selections (select all that apply)

I am able to be on top of a 1-story low-pitch roof

I am able to climb an extension ladder for painting or siding

I am retired or have flexible availability

I am working or in school with limited availability

I am available to travel to Johnstown PA to help rehabilitate houses in need

Other:

Hosanna Industries, Inc. has my permission to administer or have administered any medical attention necessary in the event of accident or injury.
*

Yes

Required

I, the undersigned, permit use of photos and/or video images portraying myself in publications promoting Hosanna Industries, Inc.

Yes

Required

I hereby release Hosanna Industries, Inc. (as well as its successor(s) and assigns) from any and all claims for damages, whether to person or property, arising from any accidents or injuries, direct or indirect, including travel to and from the day’s activities, which are caused or arise from my participating/ volunteering with Hosanna Industries, Inc. work project(s).
*

Yes

Required

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