Volunteer Waiver

Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Phone *

(###)

###

####

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.

I (or Parent/Guardian, if gleaner is under 18 years old) agree to these terms.