Last Name | First Name (required)
Your Address | City (required)
Province & Postal Code (required)
Referred by (required)
Primary Phone (required) | Cell | Work
Your Email (required)
Occupation (required) | Company / School(required)
Are you 16 years or older? (required) | Birth Date (required)
Volunteer Position (required)
This should be someone who is easy to contact, and who knows what you would like done in an emergency. Of course, we hope this information is never needed!
Address if different from above
Primary Phone (required)
Is there any medical information you would like us to keep on file here in case of emergency: (You are NOT required to provide this information)
RELEASE & WAIVER OF LIABILITY (the “Release”) signed on ______________ by _______________
(the “Volunteer”) in favor of HABITAT FOR HUMANITY PETERBOROUGH AND DISTRICT, a Canadian non-profit corporation and its directors, officers, employees, and agents (collectively, “Habitat”).
The Volunteer desires to participate in Habitat for Humanity’s activities. The volunteer does hereby freely, voluntarily, and without duress execute this release under the following terms:
WAIVER AND RELEASE: The volunteer does hereby release and forever discharge and
hold harmless Habitat for Humanity Peterborough and District and their successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from the volunteer’s participation in Habitat for Humanity Peterborough & Kawartha Region.
The volunteer understands that this release discharges Habitat for Humanity from any liability or claim that the volunteer may have against Habitat for Humanity with respect to any bodily injury, personal injury, illness, death or property damage that may result from the volunteer’s participation in Habitat for Humanity’s general build projects. The volunteer also understands that Habitat for Humanity does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance.
MEDICAL TREATMENT: The volunteer does hereby release and forever discharge Habitat from any claim
whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the volunteer’s participation in volunteer work at Habitat for Humanity Peterborough & Kawartha Region. The volunteer understands that s/he is responsible for securing appropriate medical insurance coverage.
ASSUMPTION OF RISK: The volunteer understands that the Habitat for Humanity building project may include
activities that may be hazardous to the volunteer and that the food, accommodations, and medical facilities may be donated to Habitat for Humanity and beyond the control of Habitat for Humanity.
The volunteer hereby expressly and specifically assumes the risk or harm in their activities and releases Habitat for Humanity from all liability from injury, illness, death or property damage resulting from the activities of the volunteer’s participation in volunteer work at Habitat.
Habitat for Humanity retains the right to limit or prohibit participation of the volunteer in the activities of the project if Habitat determines that such participation will not be in the best interests of Habitat for Humanity or the volunteer. The volunteer understands that s/he will be responsible for the payment of any expenses incurred as a result of application of this section.
PHOTOGRAPHIC RELEASES: The volunteer does herby grant and convey unto Habitat for Humanity all right, title, and interest in any and all photographic images and video or audio recordings made by Habitat.
OTHER: The volunteer expressly agrees that this Release is intended to be as broad and
inclusive as permitted by the laws of the country of Canada, and that this release shall be governed by and be interpreted in accordance with the laws of the country of Canada. The volunteer agrees that in the event that any clause or provision of this release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such a clause or provision shall not otherwise affect the remaining provision of this Release which shall continue to be enforceable.
IN WITNESS WHEREOF, the volunteer has executed this Release as of the day and year first above written.
Habitat for Humanity Peterborough and District respects your privacy.
Habitat for HumanityPeterborough and Kawartha Region
550 Braidwood Ave
Peterborough, ON K9J 1W1
Registered Charity # 85772 4447 RR0001
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