HOUSES FOR HEALING VOLUNTEER FORM

READ THIS BEFORE COMPLETING THE FORM BELOW


This is a volunteer activity and if any family member or I
are harmed in any way during this activity, I will not hold Big Country Good
Neighbor Day, Kim Austin or Kim Austin State Farm legally responsible for the
risks involved in this volunteer activity.

I understand photographs will be taken during the activity and I hereby grant Big Country Good Neighbor Day / Kim Austin State Farm the absolute right to use my likeness, as well as the likeness of my family members present, in the photographs / videos captured at this time for use in social media posts and advertising.

If I am bringing children other than my own, I will be responsible for the parents of the child(ren) complete this form.

Please select the “I Agree” or the “I Disagree” button on the form below before submitting the form.

Yes, I’d like to volunteer with the Houses for Healing

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Name
I am 17 years old or above *
Will you be bringing guest(s) under the age of 17? *
I have permission from the parent(s) for the child(ren) listed to be involved *
I have read and understand the Photo Release and Hold Harmless Agreement herein pertaining to my volunteer activities at the Houses for Healing.