Latino Community Fund Inc. · Family Day of Action

Name

First Name

Last Name

Email

Verify Email

Phone

Please provide the best phone number to reach you.

Zip Code

Please provide the zip code of the area where you are located.

Please check the date/s of that days you can volunteer

*

check both if you can volunteer both days.

6/26/2020

6/27/2020

Please choose the location where you want to volunteer:

*

Please select all that apply:

Latina/o/x

African Descendant

Indigenous

Asian

Caucasian

Other

Are you a college student?

Yes

No

Please Check Yes Confirming you are 16 years old or will be accompanied by an adult.

I am at least 16 years old

I am less than 16 years old but will be accompanied by an adult

Please Read the Following

Please check the box to understand that you are assume all the risks of participating in any and all activities associated with this effort of food distribution, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

I certify that I am physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity.

In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity including LCF Georgia, Consulate of Mexico, Ser Familia, Plaza Las Americas, Unidos Somos United and several churches joining this effort and their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers;

I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns.

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

Checkboxes

*

I certify that I have read, understand, and agree with the above statement. Copy

Yes