ADULT
Volunteer Registration:
Saturday, October 24, 2020 Medication & Sharps Collection
Proudly supporting the Drug Enforcement Administration's National Drug Take Back Day
Adults only:
Thank you for volunteering for HC DrugFree's medication and sharps collection scheduled for Saturday, October 24 from 10 a.m. to 2 p.m. (with set up 9:00 a.m. and cleanup from 2:00 to 2:30 p.m.). Rain or shine, this is an outdoor event in the Wilde Lake Village Center parking lot.
Please register each participant through their own individual form.
*
1.
THIS EVENT IS CLOSED. DO NOT CONTINUE. First name
(Required.)
*
2.
Last name
(Required.)
*
3.
Will you be joining/chaperoning your student or member of our Teen Advisory Council?
(Required.)
Yes
No
If Yes, name of the registered student(s) joining you:
*
4.
Email address
(Required.)
*
5.
Re-enter email address
(Required.)
*
6.
Phone number
(Required.)
*
7.
Re-enter phone number
(Required.)
*
8.
List EXACT time between 9:30 a.m. and 2:00 p.m. that you will volunteer
(Required.)
*
9.
Are you willing to volunteer rain or shine?
(Required.)
Yes
No
Other (please specify)
*
10.
Are you willing to hold a sign or direct traffic from a safe sidewalk location?
(Required.)
Yes
No
Other (please specify)
*
11.
Are you able to stand, or if you prefer to sit, will you provide your own lawn chair? (We will not provide chairs.)
(Required.)
Yes
No
*
12.
Most volunteers will not handle medication and sharps, but we are looking for trained volunteers to assist. Do you have medical training to handle medication and sharps?
(Required.)
Yes
No
13.
If you have medical training, please specify:
Doctor/Nurse
Pharmacist
EMT
Other (please specify)
*
14.
All volunteers are required to wear a mask, socially distance, and follow HC DrugFree's guidance and procedures based on CDC guidelines. Do you agree?
(Required.)
Yes
No (please specify)
*
15.
Volunteers wear HC DrugFree t-shirts, but with COVID restrictions, we may not be providing them. Do you have our t-shirt?
(Required.)
Yes
No
If no, what size in case we can provide them?
By submitting this registration, I agree to this waiver(s):
I have read this waiver and knowing the facts, I, for myself and anyone entitled to act on my behalf, waive and release HC DrugFree and its employees, directors, officers, partners, agents, and sponsors from and against all claims, demands or causes of actions for accidents, personal injury, bodily injury, death, property damage or other injury or loss or damage of any kind, occurring from any cause arising from or related to or in connection with named participant’s involvement in the event named above.
Further, I grant permission to all of the foregoing to use named participant’s photographs, audio and audio visual recordings or any other record of this event for any legitimate purpose.
Additional waiver for volunteers handling sharps & medication:
In addition to above, I understand proper handling of meds and sharps, agree to wear provided gloves and protective items, and assume the risk of picking up medications and sharps and placing them in the proper bins. I will decide the appropriate medical care for such, and I understand that it is my responsibility to IMMEDIATELY report any injury (splash, needle stick, cut, etc.) to HC DrugFree’s Executive Director or Board Member present at this event.
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