Day of Service Sign-Up & Waiver

By completing this form, you are officially signed up to attend a program of Sierra Service Project. This serves as the medical and liability waiver. Please email Director@SierraServiceProject.org or call (916) 488-6441 with any questions.

What day(s) do you want to sign up for? *

Wed, Nov 13, 9 AM - Noon: Paver Art Installation in North Sacramento (2323 Gibson Street, Sacramento, CA 95813)

Tues, Nov 19, 9 AM-2 PM: CLOSED GROUP - University of California State Governmental Relations (2323 Gibson Street, Sacramento, CA 95813)

Thurs, Nov 21, 9 AM - Noon: Paver Art Installation in North Sacramento (2323 Gibson Street, Sacramento, CA 95813)

Sat, Dec 14, 9 AM-3 PM: Dixieanne Fence Building in North Sacramento (2323 Gibson Street, Sacramento, CA 95813)

Sat, Dec 21, 9 AM-3 PM: Dixieanne Fence Building in North Sacramento (2323 Gibson Street, Sacramento, CA 95813)

Volunteer Information Form

Please Note: This form will take about 15 minutes to complete. You will need to have information ready about your medical insurance (if any). Once you have begun completing the form, there is no way to save your work in progress.

Volunteer Information

Name *

First Name

Last Name

Preferred Name

First Name

Last Name

Pronouns

Email *

Verify Email *

Mailing Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone

Phone Type

Volunteer Type *

Date of Birth *

(mm/dd/yyyy)

Grade in school *

Gender *

T-Shirt Size (adult unisex) *

Project Experience and Skills

Please let us know what kinds of project experience and skills you have.

Guardian Name & Contact Information

Required only for volunteers under 18. Serves as the emergency contact.

Parent or Guardian Name *

First Name

Last Name

Relationship to Volunteer *

Parent or Guardian Email *

Verify Email *

Parent or Guardian Phone Number *

This number will be used in case of emergency.

Phone Type *

Parent or Guardian Employer

Their employer may provide a donation to SSP based on volunteer hours!

Employer

Your employer may provide a donation to SSP based on your volunteer hours!

Medical History & Needs

The following information is required to ensure your (or your child's) individual needs are met while volunteering with SSP. Information contained herein is confidential, and will be made available only to SSP staff and medical professionals as necessary. For you (or your child's) safety and well-being, no volunteer will be allowed to participate without this.

Emergency Contact

Emergency contact *

First Name

Last Name

Relationship to Volunteer *

Emergency Contact Phone *

Phone Type *

Insurance

Coverage

This volunteer is uninsured

Health Insurance Co. *

Policy Number *

Physician *

Phone *

Does your insurance carrier require a second opinion before emergency procedures are undertaken? *

Yes

No

Date of Last Tetanus Shot *

(mm/dd/yyyy)

Date of Last Covid-19 Vaccine (highly recommended but not required)

(mm/dd/yyyy)

Allergies, Dietary, & Other Needs

Do you identify as a person with a disability? *

Physical or behavioral conditions

Please list any physical or behavioral conditions that the staff should be aware of (epilepsy, fainting, asthma, etc.) Please be specific.

Allergies *

Are you (or your child) allergic to any medication or insect bites?

Yes

No

Please list particular allergy and probable reaction. *

Dietary Needs

Please check all that apply.

Vegetarian

Vegan

Peanut Free

Nut Free

Gluten Free

Soy Free

Dairy Free

Diabetic

Other

Are any of these dietary needs related to a food allergy?

Yes

How severe is this allergy? *

What causes or triggers the allergy? *

Please check all that apply.

Ingestion

Inhalation

Skin Contact

Other

What else would you like to share about dietary needs or food allergies?

Over The Counter Medication

Unless instructed otherwise, our staff will provide over the counter medication to your child as required and as appropriate.

Does SSP have permission to give your child any over the counter medication as needed? *

Yes

No

Unapproved Medications

Please indicate those over the counter medications which we are NOT authorized to give to your child as needed.

Aspirin

Aspirin substitute

Eye ointment

Antihistamine or decongestant

Motion sickness medication

Laxative or anti-diarrhea medication

Antibacterial or antibiotic ointment

Insect bite or poison oak ointment

Specific Instructions

Note: If your child requires special care, or you would like to expand on any of the explanations you have provided here, please contact the SSP office at 916-488-6441 so that necessary arrangements can be made.

Youth Medical Release

My child has my permission to volunteer with Sierra Service Project (SSP). I understand the SSP program involves construction, and I acknowledge that reasonable measures will be taken to safeguard the health and safety of all participants. I understand I will be notified as soon as possible in case of any emergency affecting my child. In case of a medical emergency, I hereby authorize calling a physician at my expense to provide whatever medical or surgical treatment is necessary. I confirm the information I have provided on these forms is complete and correct as far as I am aware, and give permission to SSP staff as noted.

I agree to indemnify and hold harmless SSP, its officers, agents and employees from any and all claims, damages, expenses, illness, or injuries arising out of or incident to my child’s participation in this project, unless such loss or injury results directly from the neglect or willful act of an officer, agent, or employee of Sierra Service Project acting within the scope of their employment.

Medical Release

I understand the SSP program involves construction, and I acknowledge that reasonable measures will be taken to safeguard the health and safety of all participants. In case of a medical emergency, I hereby authorize calling a physician at my expense to provide whatever medical or surgical treatment is necessary. I confirm the information I have provided on these forms is complete and correct as far as I am aware, and give permission to staff as noted.

I agree to indemnify and hold harmless SSP, its officers, agents and employees from any and all claims, damages, expenses, illness, or injuries arising out of or incident to my participation in this project, unless such loss or injury results directly from the neglect or willful act of an officer, agent, or employee of Sierra Service Project acting within the scope of their employment.

Check to confirm *

I have read the above information and hereby agree.

Media Release

Check one of the following: *

SSP has my permission to use images or videos in which I (or my child) appear for Sierra Service Project’s publicity purposes.

I will (or have notified my child to) withhold from group pictures or videos that may be taken.

Complete and Submit

By entering the information below and clicking on the "Submit" button, I verify that I have completed and reviewed these forms, and that they are accurate to the best of my knowledge.

Volunteer Name *

Parent or Guardian Name *

Date *

(mm/dd/yyyy)

Suggested Donation

$30

$20

$10

$0 - Free for youth

$