BLEC Volunteer Application and Agreement

Emergency Contact Information

Name

Relationship

Phone

Medical Information

Any medical information that may be helpful in the even of an emergency: (i.e medications, heart problem, diabetes, allergies, food sensitivities):

Release:As a volunteer I recognize that problem involving physical activity have inherent risks of injury and/or damage and I assume all such risks, as well as the responsibility to be fully aware of the inherent risks. BLEC and its employees and volunteers will not be liable for injury or damage that occurs as a result of such risks, and I waive and release the BLEC and its employees and volunteers from any such liability, I also grant full permission to the BLEC to use my name, photograph, videotape or recording for any publicity promotion purposes without obligation or liability

VOLUNTEER APPLICATION AND REGISTRATION

Participant Information Section

Please indicate your availability (Center hours are 8am to 5pm)

Emergency Contact Information

Medical Information