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Rancho Cordova Day of Service Sign-Up & Waiver

By completing this form, you are officially signed up to attend a Sierra Service Project Day of Service in 2024. This serves as the medical and liability waiver. Please email Director@SierraServiceProject.org or call (916) 488-6441 with any questions.

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



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Please check all that apply.

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.

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This number will be used in case of emergency.

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

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


Insurance

Sierra Service Project purchases supplemental accident insurance coverage for all participants. The maximum accidental medical expense benefit is $3,000 for approved claims. For individuals with personal insurance, SSP's coverage will be applied in excess of benefits provided by any other plan.





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Allergies, Dietary, & Other Needs


Please list any physical or behavioral conditions that the staff should be aware of (epilepsy, fainting, asthma, etc.) Please be specific.
Are you (or your child) allergic to any medication or insect bites?

Please check all that apply.
Please check all that apply.

Over The Counter Medication

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

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

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.

Media Release

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.




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