Volunteer Information and Waiver of Liability We're Here for You! Name *Over 18? *YesNoDate of Birth *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwePhone (Primary) *What is your primary phone? *MobileWorkOtherPhone (Secondary)What is your secondary phone? *MobileWorkOtherEmail Address *Served/are currently serving in the military? *YesNoGenderFemaleMaleOtherStudentYesNoGroup or EmployerChurch/Faith OrganizationT-Shirt *SmallMediumLargeExtra-Large2X-Large3X-LargeEmergency Contact InformationName *Phone (Primary) *What is your primary phone? *MobileWorkOtherWaiver of Liability & Release of a MinorThe Volunteer hereby freely, voluntarily, and without duress executes this Release under the following terms: *Initials Required1. Release and Waiver. I expressly agree that this Release is intended to be as broad and inclusive as permitted by, governed by, and interpreted in accordance with the laws of the State of South Dakota. I understand that this Release forever discharges Habitat and its successors and assigns from any liability or claim that I may have against Habitat with respect to any bodily injury, personal injury, illness, death, or property damage that may result from my activities with Habitat, whether caused by the negligence of Habitat or its officers, directors, employees, or agents or otherwise. I understand that Habitat does not assume any responsibility for or obligation to provide financial assistance or other assistance. I understand activities may include, but are not limited to: construction; landscaping; power tool usage; loading and unloading of materials; transportation to and from work sites; and clean-up of residential home construction sites. *Initials Required2. Assumption of the Risk and Medical Treatment. I understand that Habitat does not carry or maintain health, medical, or disability insurance coverage for any volunteer; and I hereby expressly and specifically assume the risk of any activities with Habitat and release Habitat from all liability for injury, illness, death or property damage resulting from the activities. In addition, I hereby release and forever discharge Habitat from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with my activities with Habitat. *Initials Required3. Photographic Release. I hereby grant and convey unto Habitat all right, title and interest in any and all photographic images and video or audio recordings made by Habitat during my activities with Habitat, including, but not limited to: any royalties; proceeds; or other benefits derived from such photographs or recordings. *Initials RequiredBy signing below, the Volunteer and, if applicable, the parent/guardian, has read, understood, and executed this Release as of the date first above written.Volunteer Name *Date *(IMPORTANT: If the Volunteer is less than 18 years of age, all parents or guardians must also sign this Release and Waiver of Liability)Parent/Guardian Name *Date *Submit