ACTION 2007: Habitat for Humanity Marquette, Michigan June 30 – July 7
Youth Registration Form
Name:
_____________________________ Date
of Birth: __________________
Address:
___________________________ Church:
______________________
___________________________
___________________________
Phone:
____________________________ e-Mail:
_______________________
Father ‘s Name: ______________________ Daytime Phone: ________________
Hours:
____________
Mother’s
Name: ______________________ Daytime
Phone: ________________
Hours:
____________
Name
of another responsible person: __________________ Phone: ____________
Address:
___________________________
___________________________
___________________________
Medical:
(Medications, allergies, special health concerns, etc.)
Blood
Type (if known): ________________
Doctor’s Name: _________________________ Phone:
____________________
Address:
_______________________________
ACTION will be working with Habitat for Humanity in Marquette, Michigan. Habitat for Humanity is a home construction ministry. Volunteers participating in its activities will be expected to be involved in specific home construction activities including, but not limited to: roofing, carpentry, sheetrocking (or drywalling), digging and building of steps, plumbing, glasswork, insulating, painting, flooring, masonry, electrical wiring, and other facets of home construction.
Volunteers
may in their free time engage in activities including, but not limited to,
sports, hiking, boating, swimming, and other activities. Planned activities include, but are not
limited to, travel to visit places or
people of regional interest.
NOTE: Volunteers are not
required to engage in any work or recreational activity in which they feel they
are not able to safely participate.
We,
_________________________ and _________________________, parent(s) or
guardian(s)
of _________________________, a minor, jointly and severally as parent(s) and
guardian(s) of the minor child have read the foregoing statement of activities
and understand the extent and nature of the activities in which our child or
ward will participate and hereby release and discharge ACTION, Habitat for
Humanity, its agents, employees and any and all persons connected therewith
from any and all liability, claims and causes of action of any type whatsoever
arising out of or in any way connected with said child’s participation in the
activities of this trip.
We
further give our permission for our child (or ward) to be treated by competent
medical personnel as a result of any accident or medical emergency while
involved in this trip.
Signed this ______ day of __________,
2007
___________________________ __________________________
Signature/Relationship Signature/Relationship
ACTION 2007: Habitat for
Humanity Marquette, Michigan June 30 –
July 7
Adult Registration Form
Name:
_____________________________ Date
of Birth: __________________
Address:
___________________________ Church:
______________________
___________________________
___________________________
Phone:
____________________________ e-Mail:
_______________________
Name
of relative: __________________ Phone: _______________________
Address:
___________________________
___________________________
___________________________
Medical:
(Medications, allergies, special health concerns, etc.)
Blood
Type (if known): ________________
Doctor’s
Name: _________________________ Phone:
____________________
Address:
_______________________________
I
hereby give my permission to be treated by competent medical personnel as a
result of an accident or medical emergency while involved in activities of this
trip.
Date:
__________________ Signature:
________________
Are
you willing to bring your: ______
Pickup ______ Minivan ______ Car?
Capacity
of vehicle: ______ # of Passengers