Dr. Martin Luther King Jr. Day

Name *

First Name

Last Name

Cell Phone *

(###)

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you 18 years old or more? *

Yes

No

UNDER 18: Do you have permission from a parent or guardian to volunteer?

Yes

UNDER 18: Parent or Guardian Name

First Name

Last Name

UNDER 18: Parent or Guardian Phone

(###)

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Volunteer Waiver Statement *

In consideration of my desire to serve as a volunteer in community service to be conducted by the Sixth Branch, Inc. I hereby assume all responsibility for any and all risk of property damage or bodily injury that I may sustain while participating in any voluntary service or other activity of any nature, including the use of equipment and facilities of the Sixth Branch, Inc. Further, I, for myself and my heir, executors, administrators and assigns, hereby release, waive and discharge the Sixth Branch, Inc. and its officers, directors, employees, agents, partnering organizations, and volunteers of and from any and all claims which I or my heirs, administrators and assigns ever may have against any of the above for, on account of, by reason of or arising in connection with such volunteer community service or my participation therein, and hereby waive all such claims, demands and causes of action. Further, I expressly agree that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the State of Maryland, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I further certify that I have received all necessary doses and completed all necessary waiting periods to be fully vaccinated against COVID-19. I currently have no known mental or physical condition that would impair my capability for full participation as intended or expected of me. I further warrant that (1) I am not now, nor have I been for the past 10 days, experiencing symptoms of COVID-19, as described by the Centers for Disease Control; (2) I am not currently infected with COVID-19, to the best of my knowledge; (3) and I have not been exposed to a confirmed or suspected case of COVID-19 or have been diagnosed with COVID-19 and are not yet cleared as non-contagious by public health authorities or my health care provider. If I sign this form before volunteering and have any reason to suspect I might be infected with COVID-19 on the day I am scheduled to volunteer, I will not volunteer. On the day I volunteer, I will follow all social-distancing and safety guidance and instructions given by the staff of the Sixth Branch, Inc. Further, I have carefully read the foregoing release and indemnification and understand the contents thereof and, by typing my full name below, sign this release as my own, free act.

Yes, I agree