2014 New Volunteer Registration Form

2014 NEW VOLUNTEER REGISTRATION FORM

(Please print clearly)

The information provided on this form is collected and managed in compliance with

the Alberta Personal Information Protection Act (PIPA).

Name: ______

Address: ______

City/Town ______Prov ______Postal Code ______

Telephone Contact Number: (______) ______-______Email: ______

Name of School if you are a Student: ______

Age at last birthday if between 10 and 18 years of age: ______

A Parental/Guardian Consent Form must be completed and signed for all applicants 10—15 years of age. Volunteers 10—14 years of age must volunteer with an adult and be supervised by an adult at all times.

EMERGENCY CONTACT

Name ______Relationship ______

Phone: Home ( ) ______Cell (______) ______Bus (_____) ______

______

EMPLOYED: If you are volunteering on a regular basis, your employer may offer monetary grants to the organization for which you are volunteering. If you are employed and you give Heritage Park permission to contact your employer concerning a possible monetary grant, please check the YES box. If you do not wish Heritage Park to explore the possibility of a grant with your employer, please check the NO box below.

YES o NO o

AGREEMENT

I certify that the above information is true and hereby agree to provide this information to enable Heritage Park to assign duties, maintain records, and forward correspondence to me relative to Heritage Park. I agree to carry out my volunteer tasks in a reasonable and safe manner, and am willing to undergo proper training for my volunteer position and to perform my volunteer commitments to the best of my ability and abide by the guidelines of Heritage Park.

I understand that my personal information will not be used or disclosed for purposes other than those for which it is collected or as required by law and that Heritage Park’s contact list is neither given nor sold to any organization or company for any purpose whatsoever.

I understand that when I am volunteering for Heritage Park, my image may be reproduced, edited and used in whole or in part for any and all media including, without limitation, print, audio-visual, multi-media, and /or exhibition purposes, in any manner, in perpetuity and throughout the world. I understand and agree that I have no rights to any benefits derived from any such image.

I understand that Heritage Park provides volunteer accident insurance and Workers’ Compensation coverage. Volunteers are also covered for Third Party Liability while performing their duties in good faith and in accordance with Heritage Park policies.

______

Signature of Volunteer Date

______

Signature of Parent/Guardian if required Date