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Please fill out the form below, print it out, sign it and have the child bring the waiver to the work site. No child will be allowed to work on the site without a waiver. Forms can also be obtained through the Habitat for Humanity of Westchester office, 914-636-8335. This form is required for anyone whose age is 14 to 17 years. |
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| Date: __________________________ | |
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I understand that my child (or ward) will be working on a construction site and that there are dangers inherent to such. I hereby give my express and unqualified consent and permission for my child (or ward) to be present at and working on such construction site. Should an accident occur, I hereby give authorization for medical treatment to be administered to my child (or ward). I understand that Habitat For Humanity of Westchester, Inc. cannot be liable for any injuries or illness that my child (or ward) may suffer while engaged as a volunteer in their program. I expressly waive any such claim for compensation or liability on the part of Habitat For Humanity of Westchester beyond: |
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| a) | what may be offered freely by representatives of Habitat For Humanity of Westchester in the event of such injury or medical expense, and |
| b) | what may be provided under Habitat For Humanity International's group volunteer accident and general liability insurance programs in which Habitat For Humanity of Westchester participates. |
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By signing this parent permission, I acknowledge that I understand and give permission for my child (or ward) to be present at and working on such construction site, authorize medical treatment to be administered to my child (or ward), and agree to the above waiver of liability. |
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| Name | |
| Address | |
| City | |
| State | |
| Zip Code | |
| Child's (or ward's) Name | |
| Home Phone# | |
| I have filled out a Volunteer Information Sheet Yes No (If no, please complete one today if you intend to continue to work with Habitat) |
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| Signature: ___________________________________________ | |
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For office use only (please don't fill out below) |
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| Entered in Volunteer database/updated database | |
| Date: __________________ by: _______________________________ | |
