2016 Paddle to Nisqually Volunteer Form - *Completed and Approved Application Required to Participate Question Title * 1. Enter Applicant Information First Name Middle Initial Last Name DOB - mm/dd/yyyy Driver's License Number Question Title * 2. Email Address Question Title * 3. Mailing Address Street City State Zip Code Country Question Title * 4. Phone numbers (Provide at least one) Land Line Mobile/Cell/Messages Question Title * 5. Preferred Method of Communication (Choose one) Email Phone Question Title * 6. Affiliation (e.g. Organization/Canoe Family Name - Choose one) Nisqually Tribe Canoe Family Non-Profit Organization For-Profit Organization Individual Other List Affiliation Name Question Title * 7. Emergency Contact Information Emergency Contact Name Emergency Contact Phone Question Title * 8. Select Dates Available to Work Sat 7/30 Sun 7/31 Mon 8/1 Tue 8/2 Wed 8/3 Thu 8/4 Fri 8/5 Sat 8/6 Question Title * 9. Select Times Available to Work From Time AM/PM - AM PM To Time AM/PM - AM PM Question Title * 10. Please Select Priority Preference of the Volunteer Areas(Drag and Drop choices starting at top of list - 1 meaning first choice and click N/A if not applicable for your choice) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Culture/Hospitality N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Elders N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Equipment N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Event N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Green Team N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Host Family Camping N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Kitchen & Cleanup N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Meals/Food N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Media N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Medical N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Public Works & Camping N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Safety & Security N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Transportation & Parking N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Vendors N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Volunteers/Staffing N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 N/A Youth Activities N/A Question Title * 11. I have read and agree to the Release & Waiver of Liability as stated below. Yes No Paddle to Nisqually 2016 Release & Waiver of LiabilityThis is a Release and Waiver of Liability between Volunteer and Nisqually Indian Tribe (herein “TRIBE”) forParticipation in the 2016 Paddle to Nisqually. Please read this document carefully – it is a legally bindingagreement and your signature below indicates that you as Volunteer agree to all of the terms contained inthis document.1. Waiver and Release. Volunteer does hereby release and forever discharge and hold harmless TRIBE and itssuccessors and assigns from any and all liability, claims and demands of whatever kind or nature, either in lawor in equity, which arise or may hereafter arise from Participation. Volunteer understands that this Releasedischarges TRIBE from any liability or claim that the Volunteer may have against TRIBE with respect to anybodily injury, personal injury, illness, death, disability, or property damage that may result from Participation,whether caused by the negligence of TRIBE or its o?cers, directors, employees or agents, other Volunteers, orotherwise.2. Medical Treatment. Volunteer does hereby release and forever discharge TRIBE from any claim whatsoeverwhich arises or may hereafter arise on account of any ?rst aid, treatment or service rendered by any person inconnection with Participation with this event.3. Assumption of the Risk. Volunteer acknowledges that there are potential hazards (“Hazards”), known andunknown, involved in Participation. The term “Hazards” is intended to be used in its broadest sense andincludes, but is not limited to natural hazards (land, weather, etc.) and man-made hazards (concrete, steel, etc.),food contamination, as well as hazards typical for playing gaming equipment and competitive games. TheVolunteer understands and acknowledges that Participation may include Hazards that could harm theVolunteer, and that such Hazards mayor may not always be obvious. Volunteer hereby expressly andspeci?cally assumes the risk of injury or harm for all such Hazards and releases TRIBE from all liability for injury,illness, and death or property damage resulting from Participation.4. Photographic Release. Volunteer, without entitlement to any additional compensation, does hereby grantand convey unto TRIBE authorization to use in perpetuity, and all right, title and interest in any and allphotographic images and video or audio recordings made by TRIBE that depict Volunteer. Volunteerunderstands that any images of the Paddle will be used in a respectful way to honor the Participants and Spiritof the event.5. Parent/Guardian Authorization. For any Participant who is not yet 18 years of age as of the date signedbelow, a parent or legal guardian must read the terms of this agreement along with the minor and sign below. Ihave read all the terms of this Agreement and by signing below I express my understanding and intent toenter into this Release and Waiver of Liability willingly and voluntarily. I also acknowledge that I consent toa background check and urine analysis.Signed electronically this date (mm/dd/yyyy) of: Question Title * 12. Digital Signature - Note: /s/ denotes digital signature. Applicant Digital Signature /s/ Parent or Guardian Digital Signature (If applicant is not yet 18 years of age as of signed date) /s/ Done
