Volunteer Waiver application can be printed from HERE and
mail to Rebuilding Together North Jersey’s office at PO Box 1389, Ridgewood NJ 07451-1389.
Also, you may complete our on-line application:
Volunteer Name

Time in: Time out:
Rebuilding Together North Jersey
Volunteer's Agreement and Release from Liability
 

1. Voluntary Participation. I acknowledge that I have voluntarily applied to assist in the Rebuilding Together North Jersey project (the "project"), a project in which the homes of disadvantaged persons or non-profit facilities will be repaired by volunteers. I understand that the Project is currently scheduled to occur on , however, that date may be changed at the sole discretion of Rebuilding Together North Jersey, Inc.

I understand that as a volunteer that I will not be paid for my services, I will not be covered by any medical or other insurance coverage provided by Rebuilding Together North Jersey, Inc. and that I will not be eligible for any Workers Compensation benefits. I further agree that my participation in the Project may be terminated at any time by either Rebuilding Together North Jersey, Inc., or me.

2. Assumption of Risk. I AM AWARE THAT, IN PARTICIPATING IN THIS PROJECT, I MAY BE EXPOSED TO PERSONAL INJURY OR DAMAGE TO MY PROPERTY AS A RESULT OF MY ACTIVITIES, THE ACTIVITIES OF OTHER VOLUNTEERS, OR THE CONDITIONS UNDER WHICH MY VOLUNTEER SERVICES ARE PERFORMED. WITH KNOWLEDGE OF THESE DANGERS, I AGREE TO ACCEPT ANY AND ALL RISKS OF INJURY OR DEATH, AND VERIFY THIS STATEMENT BY PLACING MY INITIALS HERE: .

3. Release. In consideration of the opportunity afforded me to assist in this Project, I hereby agree that I, my assignees, heirs, guardians and legal representatives, will not make a claim against Rebuilding Together North Jersey, Inc., or any of its affiliated organizations, or of their officers, directors, employees, sponsors and donors, of the supplier of any materials of equipment that is used by the Project, or any of the volunteer workers, for injury, damage or death resulting from the negligent acts or omissions of any person or entity, however caused, arising from my participation in the Project. Without limiting the generality of the foregoing, I hereby waive and release any rights, actions or causes of action resulting from personal injury or death to me, or damage to my property, sustained in connection with my participation in the Project. I further consent to the unrestricted use by Rebuilding Together North Jersey, Inc. and/or any person authorized by them of any photographs, recordings, interviews, videotapes, motion pictures or similar visual or auditory recording of me in connection with the Project.

4. Knowing and Voluntary Execution. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND Rebuilding Together North Jersey, Inc., AND I DO SIGN IT OF MY OWN FREE WILL, BY SIGNING THIS AGREEMENT I CERTIFY THAT I AM EIGHTEEN YEARS OF AGE (OR OLDER) OR I HAVE DELIVERED THE CONSENT OF MY PARENT OR GUARDIAN TO Rebuilding Together North Jersey, Inc.

Executed on , at (worksite): , New Jersey
Volunteer Signature
Volunteer Name (Print)
Email
Mailing Address
Town       State   Zip
Phone
 

Parent or Legal Guardian (if volunteer is under 18 years of age)

Name       Relationship
Signature
Telephone
 
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I certify that acknowledged in my presence that he/she had read and fully understood the meaning and consequences of the foregoing RELEASE, and signed it in my presence.
 

Rebuilding Together North Jersey, Inc.
BY: , Volunteer Coordinator


Rebuilding Together North Jersey
P.O. Box 1389, Ridgewood, NJ 07451-1389 (201) 447-8886