Volunteer Waiver

Name *
Birthdate *
Phone *
Would you like to receive Iskashitaa Refugee Network emails?
Emergency Contact
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
-List any allergies to medicine, foods, etc. -List any history of serious illness (diabetes, asthma, epilepsy, etc.) or recent injuries or hospitalization -Date of last tetanus shot -What medications are presently being taken?

(If in a group list the name of the group)

Liability Waiver
Should I suffer an accident or be taken ill during a gleaning event, I give my permission for any emergency hospitalization, medication or surgery deemed appropriate by a doctor. I have been assured that safety is paramount during any gleaning, and that the adult staff of Iskashitaa will exercise all reasonable care for those involved. I know that I must bring adequate water, sunscreen, a hat and a snack. I will not hold the staff, interns or any other Iskashitaa volunteer liable in the case of accidental injury or death during any gleaning event. Nor will I hold the person(s) who owns or operates the property we glean liable for such injury or death. Gleaning photos or videos in which I appear may be used by Iskashitaa in newsletters or for promotional purposes.