2021 April Merriman Hollow Workday Volunteer Registration and Waiver
This survey is for Merriman Hollow Maintenance Workday on Saturday, April 17 at 9am-noon.

Please wear a face mask and bring gloves and a reusable water bottle to stay hydrated.

Please contact Jenny Petoskey (petoskeyjennifer@gmail.com) for any questions about the event.
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Email Address *
First Name *
Last Name *
Daytime Phone Number (use format 313-123-4567) *
City *
Number attending
Please include the names and ages of any youth under the age of 18 that you would like to register. By adding them here, you agree to include their answers as part of your responses to questions 1-4.
1. Are you currently suffering from any of the following symptoms – fever, cough, shortness of breath, sore throat, new loss of smell or taste, and/or gastrointestinal problems, including nausea, diarrhea, and vomiting? *
2. Have you lived with, or had close contact with, someone in the last 14 days diagnosed with or displaying the symptoms of COVID-19? *
3. Have you traveled via airplane in the last 14 days? *
4. Has anyone you live with, or consider part of your “household” taken the COVID-19 test and not yet received results in the last 14 days? *
I agree not to attend the event if any of the answers to questions 1-4 are yes. I also agree to ask myself the same four questions within 24 hours of the event and excuse myself if any answers have changed to yes. *
Waiver: I, the undersigned, being of lawful age or the parent or legal guardian of the volunteer involved in the Friends of the Rouge Program in consideration of being allowed to participate in the Program, I hereby release, discharge, and forever acquit Friends of the Rouge, a non-profit organization, and its officers, agents, employees, contributors, and sponsors from any and all actions, causes of action, claims or any other liabilities whatsoever, known or unknown, or may arise in the future, on account of or in any way related to or arising out of my participation in the Program. I am interested in participating in the Program. I understand that the Program can be hazardous, and that I may be harmed or injured while participating in the Program, being present at or near the location of the Program, or arriving at or returning from the Program, perhaps in unexpected ways. I understand that the Friends of the Rouge Program make no representations or warranties as to the safety of the Program and is not an insurer of my safety. I also understand that the Friends of the Rouge Program does not control the location of the Program, or the land/water on which it occurs. Furthermore, I understand that there is no insurance coverage for the Program. Further, I hereby acknowledge that Friends of the Rouge is doing everything they can to protect the public as well myself as a volunteer. To this extent, I agree to follow Center of Disease Control (CDC) and local health district guidelines and Friends of the Rouge policies and procedures to reduce the spread of COVID-19 including pre-screening, pre-registration and sign-in, exercising physical distancing, wearing a face covering, frequently washing or sanitizing hands, reporting any changes in health status, agreeing to work in assigned group and not sharing any tools or food and water. I agree to report any change in my health status as it relates to the CDC published COVID-19 symptoms(cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste/smell) for a period of 14 days before and after my volunteer event. It is understood and I grant permission to the event organizer to make a reasonable effort to notify others I may have come into contact while volunteering so they can self-isolate themselves and monitor their own health status. It is understood that event organizers will NOT disclose my personal identity or reported health information.I understand that I may be informed of or encounter sensitive Personal Health Information (PHI) for those that Friends of the Rouge serves. I agree to hold this information in confidence and will not disseminate any PHI except as allowed by law and/or per the policy and procedures of said organization, which I am participating in. I understand that there is no direct medical health coverage afforded to me during my relationship with Friends of the Rouge. Friends of the Rouge is not responsible for any potential exposure to COVID-19, which is not a direct result of negligence on the part of their employees, volunteers, or the organization. By signing below, I agree to comply with the written instructions above. Failure to comply with these written instructions or verbal instructions from staff may result in my participation privileges being removed and I may be asked to leave the premises. This Release shall bind and inure to the benefit of the parties hereto and their respective successors, assigns, heirs, legal representatives, administrators, executors, and guardians. I represent that I am at least 18 years of age, and that if I under 18 my parent or legal guardian has signed below.
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