Volunteer Registration
RequiredRequired Question(s)
Rebuilding Together Kansas City
Emergency Medical Treatment & Waiver of Liability
VOLUNTEER REGISTRATION FORM
 
     In consideration of the opportunity afforded me to assist Rebuilding Together Kansas City (RTKC), in which homes of disadvantaged residents will be repaired by volunteers, I am a volunteer that provides services on a purely charitable and voluntary basis. In light of the aims and purposes of the community service provided by RTKC in organizing this project, I, the undersigned, hereby waive any right or cause of action arising as a result of my participation in any RTKC project from which any liability may or could accrue against RTKC or its officers and directors collectively or individually. Without limiting the generality of the foregoing, I agree that this waiver shall include any rights or causes of action resulting from personal injury to me or damage t my property sustained in connection with my activities while volunteering for RTKC. Further, I agree to hold RTKC, and all people participating in any RTKC project, blameless for any accident while in transport while volunteering for RTKC.
 
     I understand that in the case of an illness or injury to myself, an RTKC volunteer will try to phone the emergency contacts provided, and I will allow them to secure medical treatment for those health conditions.  If need be, I give permission for the attending physician to provide the proper treatment and to hospitalize if necessary.  I, the undersigned, release RTKC, RTKC workers, donors/supporters/shareholders of RTKC, and anyone participating on behalf of RTKC from all liability in case of illness or injury at all times while I am volunteering for RTKC.  If we do not carry health insurance, then RTKC and its participants are not responsible for the expense of any medical treatment received.
 
     By signing my name below, I also hereby consent to the use of photographs and/or videos of those identified below and/or the statements attached hereto, including my personal name or the firm name, by Rebuilding Together Kansas City and its subsidiary and affiliated companies and their respective dealer and distribution organizations for advertising or publicity in printed, recorded or electronic media. I represent that I am of legal age and that I have authority to give this consent which will remain in effect until revoked by me in writing.
 
Required 1.
Volunteer Crew:
 

50 characters left.
Required 2.

Crew Leader(s):

 

50 characters left.
VOLUNTEER INFORMATION:
 
Required 3.
Please enter the information indicated below.

First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required 4.
Adult T-Shirt Size:
S
M
L
X.
2XL
3XL
5.
Emergency Contact & Phone Number:
 

350 characters left.
Required 6.
Are you age 19 and up?
Yes (go to Electronic Signature)
No (go to Youth Volunteer section)
Emergency Medical Treatment & Waiver of Liability
YOUTH VOLUNTEER FORM
for Youth ages 18 and under
 
     In consideration of the opportunity afforded my child to assist Rebuilding Together Kansas City, Inc. (RTKC), in which the homes of disadvantaged persons will be repaired by volunteers, and in light of the aims and purposes of the community service provided by RTKC in organizing this event, I give my permission for my child to participate as a volunteer for RTKC, and I, on behalf of my child and myself, waive any right or cause of action arising as a result of my child's participation in any RTKC project from which any liability that may or could accrue against RTKC, or its officers and directors collectively or individually. Without limiting the generality of the foregoing, I, on behalf of my child and myself, agree that this waiver shall include any rights or causes of action resulting from personal injury to my child or damage to my child's property sustained in connection with my child's activities while volunteering for RTKC.
 
     Further, my child is a volunteer that provides services on a purely charitable & voluntary basis. I agree to hold RTKC, and all people participating in  any RTKC project, blameless for any accident involving my child while in transport while volunteering for RTKC. I understand that in the case of an accident, illness, or injury to my child, an adult volunteer will try to phone the emergency contacts provided, and I will allow them to secure medical treatment for those health conditions. If need be, I give permission for the attending physician to provide the proper treatment and to hospitalize if necessary. I, the undersigned, release RTKC, RTKC workers, donors/supporters/shareholders of RTKC, and anyone participating on behalf of RTKC from all liability in case of illness or injury at all times while my child is volunteering for RTKC. If we do not carry health insurance, then RTKC and its participants are not responsible for the expense of any medical treatment received.
 
    By signing my name below, and I, on behalf of my child, also hereby consent to the use of photographs and/or videos of those identified above and/or the statements attached hereto, including my personal name or the firm name, by Rebuilding Together Kansas City and its subsidiary and affiliated companies and their respective dealer and distribution organizations for advertising or publicity in printed, recorded or electronic media. I represent that I am of legal age and that I have authority to give this consent which will remain in effect until revoked by me in writing.
 
7.

Youth Parent/Guardian Name:

 

50 characters left.
8.

Youth Parent/Guardian Phone:

 

50 characters left.
9.

Youth Parent/Guardian Email:

 

50 characters left.
Required 10.
Electronic Signature Agreement
By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By selecting "I Accept" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and Rebuilding Together Kansas City. You are also confirming that you are the volunteer and/or parent/guardian authorized to enter into this Agreement. You further agree that your participation on Rebuilding Day equates to your E-Signature and constitutes your agreement to be bound by the terms and conditions of these Disclosures and Agreement as they exist on the date of your E-Signature on this form.

I Accept
I Decline