Work Day Volunteer Agreement

The form needs to be completed by individuals 13 years and older. If the volunteer is under 13 and attending a Work Day without a parent or guardian, the form may be completed on its own.
Personal Information














Health Information

Allergies



Dietary Restrictions



Emergency Contact






Children 13 and older will need to complete their own form.
Children Under My Care (12 and under)







Health Information

Allergies



Dietary Restrictions



Event Information






Medical Release
I certify that all the responses on this Health Information form are true and accurate, and I will notify the camp director hereafter of any relevant changes in my health that occur during my time at Camp Daniel, Inc.

I verify that:
  1. I have provided Camp Daniel, Inc. with all medical data and my other personal information necessary for a safe and healthy experience. There are no physical or mental health-related reasons or restrictions which preclude or effect my participation in the program, and
  2. If I become injured in the course of my participation, and am unable to seek treatment for myself, I hereby give permission for emergency medical treatment to be sought for me by representatives or agents on behalf of Camp Daniel, Inc.
Furthermore, I authorize the release of information contained within any health/emergency forms submitted in preparation for this program to my physician, program leaders, or third party provider (if applicable), to inform and discuss reasonable accommodations and/or to deal with any health-related emergency that directly concerns me or involves me in any way, shape, or form while participating in this program.

Assumption of Personal Responsibility, & Release and Waiver of Liability
I, (the “Volunteer”), have chosen to work as a volunteer in a Volunteer Work Day(s) in partnership with Camp Daniel, Inc. I understand that I will be serving as a volunteer (or independent contractor) for Camp Daniel, Inc. and will be participating at my own risk. I acknowledge that my participation is voluntary and does not constitute a condition or requirement of employment. In consideration for the benefits and privileges associated with my participation in this program, I acknowledge and agree to be bound by the following: 
  1. Identification of Risks. I understand that my activities may include but are not limited to the following: working at the Camp Daniel offices and worksites; working at Camp Daniel program and/or event operations; loading and unloading materials; traveling to and from work sites, towns, or cities; consuming food available or provided; living in housing provided for volunteers; constructing and remodeling residential/commercial buildings; other construction-related activities; and other volunteer activities (“Activities"). I understand that my Activities may include work that may be hazardous to me, including, but not limited to, exposure to lead, asbestos, and mold, which may cause or worsen certain illnesses, especially if I do not wear protective equipment, am exposed for extended periods of time, or have a pre-existing immune system deficiency. 
  2. Acknowledgement of Risk. I acknowledge the risk inherent in the Activities and agree to assume that risk.  I also agree to verify with my physician that I have no physical or psychological problems that would prohibit or limit my full involvement. I will submit current health information to the Camp Daniel staff on the Emergency Medical Form for any medical or emotional condition which may effect my safe participation in the Activities. 
  3. Assumption of Personal Responsibility. I agree that I am responsible for my safety while participating in the Activities and I am willing to assume that responsibility. This means that I agree to abide by all applicable federal, state, and local laws, as well as follow any instructions and directions given me by the Camp Daniel staff, and will seek to act carefully and with good judgment at all times. I will not create an unsafe situation for other individuals or myself nor will I use any tool or engage in any task with which I am not completely comfortable. If I see any situation that I feel unsafe, I will immediately call it to the attention of the onsite project coordinator. If I bring any children 12 years and under with me to participate as volunteers, I will be solely responsible for providing for their safety and will keeping them under close supervision at all times. In addition, each child will be listed on this waiver and are bound to the terms of this agreement.
  4. Waiver and Release. In light of the above, I waive, release and discharge any and all claims for damages of death, personal injury or property loss which I, or my child(ren), may have as a result of my(our) participation in the Activities. I understand that these injuries and losses might result from the actions, inactions, or carelessness of other participants as well as from my own actions related to the Activities. More specifically, I hereby hold Camp Daniel, or any individual acting in an official or advisory capacity for Camp Daniel, harmless and release Camp Daniel and its agents from any liability and claims arising out of an accident or stressful incident during the program, except where caused by the gross negligence or wanton misconduct of any of the released parties. I intend this waiver and release to also apply to any relatives, heirs, next of kin, personal representatives, or assigns who might pursue any legal action or claim on my behalf. 
  5. Health-Related Expenses. I currently have, and agree to maintain throughout my participation, valid and sufficient medical and accident insurance. I understand that this is my sole responsibility and release all Camp Daniel persons and entities from providing this coverage for me. I understand and agree that I am completely responsible for any and all of my own expenses, including but not limited to treatment, diagnosis, hospitalization, prescriptions or follow-up for any physical or mental health issues that arise for me, whether or not these expenses are covered by my insurance. 
  6. Emergency Authorization. I hereby give permission to the medical personnel selected by the camp director to administer first aid, and to order x-rays, routine tests, and treatment. In the event of an emergency, I hereby give permission to the physician selected by the camp director to hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for the Volunteer. This form may be photocopied for use out of camp. 
  7. Camp Daniel Photo Authorization Release. I hereby grant to Camp Daniel authorization to use the photographs taken of myself (if 18 or older). I understand that the pictures have been taken for use in official Camp Daniel materials (print, Internet and other media) and will be utilized at the professional discretion of Camp Daniel staff. 


Type out full name as form of signature.

Type out full name as form of signature.

Contact Information