ImagineWorks Adult Volunteering Form
Applicant must be 18 years of age or older
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First Name *
M.I.
Last Name *
Gender
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Date of Birth *
MM
/
DD
/
YYYY
Mailing Address *
City *
State *
Zip Code *
Home Phone
Cell Phone *
Email Address *
Occupation
Employer
Emergency Contact #1 Name *
Emergency Contact #1 Phone Number *
Emergency Contact #2 Name
Emergency Contact #2 Phone Number
Consent
In volunteering for ImagineWorks, authorizing participation in activities and programs of ImagineWorks (IW) and to use its facilities, equipment, machinery, tools, and in addition to the payment of any fee or charge, I do hereby waive, release, and discharge IW and its officers, agents, employees, representative, executors, and all others from any and all responsibilities or liability for injuries or damages resulting from my participation in any actives sponsored by IW. I do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any those mentioned or others acting on their behalf or in any way arisen out of or connected with my participation in any actives hosted by IW or the use of any equipment provided by IW. Volunteer applicants ages 18 years and older consents to a criminal background check and ma be asked to be fingerprinted according to state law (child protection act) and IW policy. By signing below I agree to this consent and release agreement.
Electronic Signature *
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