ASPKLNH - Fire Truck Pull Volunteer Form 2023

VOLUNTEER

We cannot make this amazing event happen without the support of our volunteer Organizing Committee and the help of Event-Day volunteers.

Want to help? Sign up to be an Event-Day volunteer today!

Constituent fields

Field Is Required First Name

Field Is Required Last Name

Field Is Required Street 1:

Field Is Required Street 2:

Field Is Required City/Town:

Field Is Required Province / State:

Field Is Required Postal / ZIP Code:

Field Is Required Email:

Field Is Required Phone Number:

I would like to receive email communications from Alzheimer Society of Peterborough, Kawartha Lakes, Northumberland and Haliburton.

Field Is Required Preferred method of communication

Does your Employer/School offer any of the following:

What is your connection to the Alzheimer Society PKLNH?

Field Is Required Why do you want to volunteer with the Alzheimer Society PKLNH?

Other/Additional Reasons: (Maximum response 255 chars, approx. 5 rows of text)

What skills do you have that you are interested in sharing with us? (Maximum response 255 chars, approx. 5 rows of text)

Field Is Required Emergency Contact Name (Maximum response 255 chars, approx. 5 rows of text)

Emergency Contact Relationship (optional) (Maximum response 255 chars, approx. 5 rows of text)

Field Is Required Emergency Contact Phone Number (Maximum response 255 chars, approx. 5 rows of text)

Field Is Required Have you ever been convicted of a criminal offense for which you have not received a pardon?

Volunteer Waiver & Liability Release: I waive and release any and all claims for myself, my heirs, my next of kin, executors, administrators and assigned representatives against the Alzheimer Society of Peterborough, Kawartha Lakes, Northumberland and Haliburton (hereinafter collectively referred to as the ASPKLNH) and any other sponsor or organization involved, from any and all liability for any loss, damage, expense, or injury including death or incapacity, however caused, including any claim or liability arising from the negligence of the ASPKLNH and its agents (employees, students, volunteers) arising out of, or in the course of, my participation as a volunteer for which I choose to participate. This Release and Waiver extends to any and all claims, foreseen and unforeseen, known or unknown. I agree to HOLD HARMLESS AND INDEMNIFY the ASPKLNH from any and all liability for any property damage or personal injury to any third party resulting from my participation in volunteer activities with the ASPKLNH. I understand that as a volunteer with the ASPKLNH I am NOT covered by the Ontario Workplace Safety and Insurance Act and that, as a result, I am not entitled to make any claims for compensation pursuant to the Ontario Workplace Safety and Insurance Act. I agree not to make any statements, written or verbal, that defame, disparage or in any way criticize the personal or business reputation, practices, or conduct of the ASPKLNH and its agents.

Field Is Required Select an option:

18 years and older: I have read and understood the waiver and am legally able to sign it
17 years and younger: I understand that before becoming an active volunteer I must submit a waiver signed by my guardian/parent.