Rebuilding Together Southern Nevada 611 S, 9" St. Las Vegas NV 89101 702-259-4900 702-259-8600 (fax) | WOULD LIKE TO VOLUNTEER! Please Print Name: nisie bi Organization: Home Phone: __(E\\:_ GQ5-3\D- 22 Work Phone: w/b Address: 405i9 Autumn St City: LAS Vpo0e, State: NIV Zip:__24\20 Icanhelp: _V National Rebuilding Day-Last Saturday in April Heroes at Home-November Date TBD Events throughout the year Unskilled labor: am willing and able to work but have no specific skills. X__ 1am willing and able to work and can do Spay} moctiiicationss to Nome envionmelt Skilled labor © Carpentry 0 Electrical 0 Gardening o Masonry Heating AIC o Plumbing © Roofing 0 Other Other | would like to serve as a House Captain, coordinating volunteers at the work site. | would like to volunteer my time in preparing work at the site or do follow up work, This may include skilled and/or unskilled tasks and working with a group the weekend before or the weekend following the event. | would like to sort supplies at the warehouseIhave a truck and can help transport supplies. | would like to participate in other ways: Photographer/video artists Delivery of supplies to rehab site ‘Set up or clean up on event day Be available as a runner on event day Pick up signs and supplies and return to office ‘Serving on the Board of Directors or being a Committee Chairman | could assist in the following areas not mentioned above Please include volunteer waiver form with your signup sheet. Volunteers under 48 years of age must have Parental Permission Waiver also signed. Donations: | would like to make a cash donation: Enclosed is a check for $ made payable to Rebuilding Together Southern Nevada. | understand that Rebuilding together maintains 501-C3 non-profit status with the Internal Revenue Service and that | will receive a receipt for my donation. | would like to be a Sponsor, Please send me a sponsorship packet Spreading the spirit of volunteerism through home repair and rehabilitation by helping low income, disabled and elderly homeowners in communities across America.REBUILDING TOGETHERN SOUTHERN NEVADA VOLUNTEER'S AGREEMENT AND RELEASE FROM LIABILITY i, Voluntary Participation. 1 acknowledge that I have voluntarily applied to assist in the Rebuilding Together Southern Nevada Home Repair Project a project in which the homes of disadvantaged persons will be repaired by volunteers. I understand as a volunteer that I will not be paid for my services, that I will not be covered by any medical or other insurance coverage provided by Rebuilding Together Southern Nevada, 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 Southern Nevada 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 signing below. 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 Southern Nevada, or any of its affiliated organizations, or either of their officers or directors, or the supplier of any materials or 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; provided, however, that the loss or damage was not caused by an act or omission that was reckless, wanton, intentional, or grossly negligent. I further consent to the unrestricted use by Rebuilding Together Southern Nevada 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 page and fully understand its contents. I am aware that this is @ release of liability and a contract between myself and Rebuilding Together Southern Nevada, and sign it of my own free will. By signing this agreement I certify that I am eighteen years of age (or older) or have delivered the consent of my parent or guardian to Rebuilding Together Southern Nevada, Executed at Toure. Winvessity (tun jevade, on Seotemiverteze Utes Kneasl Fuse Hava, Volunteer (signature) hvisten Please Print Name 405b Purumn 3 Las Vanes, WW 24120 Address O15 Hrisien Wacaid@ nv. urd . ede E-mail