Appendix: Volunteer Forms
VOLUNTEER REGISTRATION FORM
This portion of the form to be filled out by the Volunteer:
Social Security No: _____________________ Last Name: ________________________ First Name:____________________________Middle Name:_____________________ Preferred First Name:___________________Date of Birth: ______________________ Gender: ο Female ο Male |
Permanent Address: _______________________________________________
City: __________________ State: ________Zip Code: __________
Telephone #: _________________________________
Do you have health insurance? Yes ___ No ___ if yes, please provide the following optional
information: _________________________
Medical Insurance Carrier: (Optional)________________________________________________
EMERGENCY CONTACT INFORMATION: Contact Last Name: _____________________ First: ____________________Middle:_______________ Relationship_______________________ Address: Street: ______________________________City: _________________State:______ Zip: ___________ Phone:( ____ ) -____________Ext:_________________ |
I have carefully read the Canisius College Volunteer Policy and information above and understand their contents. The above information provided by me is accurate.
________________________________________________________
Volunteer’s Signature Date
This portion of the form is to be filled out by the department supervisor:
Department Head | Title | Email Address |
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Unit | Telephone Number | Begin and End Dates |
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Description of Volunteer Duties:
______________________________________________________________________________
______________________________________________________________________________
______________________________________ _________________
Department Head Signature Date
Please submit this form to Human Resources.
VOLUNTEER RELEASE AND WAIVER OF LIABILITY
Please read this document carefully before signing
I,__________________________________________________, desire to voluntarily participate without compensation in the department of________________________________, at Canisius College. Therefore, I hereby covenant with Canisius College that I shall not sue or bring any legal action or proceeding against Canisius College or its board of trustees, employees, agents, officers, faculty, students, or representatives on account of any injury or damage, including death, that I may sustain by virtue or arising out of my work as a volunteer and/or use of the equipment of Canisius College.
I acknowledge that my work as a volunteer and/or use of the equipment of Canisius College shall be at my sole risk and that Canisius College, its board of trustees, employees, agents, officers, faculty, students, or representatives shall not have any responsibility whatsoever with respect thereto.
I acknowledge that I have read this document carefully and that I fully understand and accept all provisions of the waiver.
I certify I am at least eighteen years of age and voluntarily sign this waiver.
Signature___________________________________ Date______________________________
Witness____________________________________ Date______________________________
