Volunteer Signup

Volunteer Shift Registration

Name
Name
First Name
Last Name
Address
Address

Emergency Contact

First Name
Last Name

Volunteer Information

Have you worked with ATH/UPP previously?
Who's Volunteering?

List volunteers' names

Name
Name
First Name
Last Name
Are they a minor? (below the age of 13 yrs)

Waiver Information

In consideration for receiving permission from Urban Produce Push (“UPP”) to participate in gleaning/volunteer activity, I, the undersigned participant, expressly assume all risks associated with participation in gleaning and/or traveling to and from gleaning/volunteer activity including carpooling, including without limit, accident, injury, bodily harm or death, and agree to take reasonable precautions to avoid injury to myself and others. For myself and my heirs, representatives, and assigns, I hereby release, waive, discharge and hold harmless UPP and its directors, officers, employees and agents from all liability and claims of whatever nature, INCLUDING NEGLIGENCE AND/OR FAULT, which I or any person claiming through me may have arising from or in any way related to my voluntary participation in gleaning/volunteer activity. Neither will I hold liable the landowner or operator for accidents, injury or death during gleaning. I agree to follow all instructions from UPP staff and its agents. EVEN IF I CONTEND THAT INJURY IS THE RESULT OF NEGLIGENCE OR FAULT ON THE PART OF UPP of the farmer or landowner. I UNDERSTAND THAT I AM WAIVING ANY AND ALL CLAIMS OF NEGLIGENCE.

If I suffer an illness or injury requiring emergency treatment or other medical services while participating in gleaning/volunteer activity, I give my permission for any medical treatment deemed necessary and reasonable under the circumstances and agree that UPP and its agents will not be liable nor financially responsible for such medical treatment.
I grant UPP permission to take photographs and videos of me during gleaning/volunteer activity and to display, publish or otherwise use any photographs, videos or any other media associated with gleaning/volunteer activities which contains my image or likeness, for UPPs purposes, including without limit, news coverage and promotion purposes, including print, broadcast, web and mobile. (Alert staff on site when you volunteer if you choose to decline)

By checking the box, I acknowledge that I have read and understand this form and that I am at least 18 years of age.

Minors

PARENTAL CONSENT, if gleaner is under 18 years of age. I am the parent or legal guardian of the participant and give my permission for him/her to participate in gleaning/volunteer activity with UPP. I make all of the representations and agree to the terms with respect to my child’s or ward’s participation in gleaning/volunteer activity, including without limit, releasing UPP from all liability and claims on my and the participant’s behalf and assuming all risks of his/her participation. I understand that I am responsible for the obligations and acts of participants as described in this document. I agree to be bound by the terms of this document.

Anyone up to 13 years old must stay accompanied by an adult for the entire duration of the service. We do not have a minimum age limit, but please use your best judgement when having a small child join you to volunteer. We want your child to be safe and accounted for at all times.

By checking the box, I acknowledge that I have read and understand this form and that I am a parent/legal guardian of the person named above.