2017 Rebuilding Day Volunteers

* Required

Volunteer Information

I volunteered before

First Name *


Last Name *


Address *


Address2


City *


State *


Zip Code *


Organization


Cell Phone Number *


Email *


Please confirm email address *

Special Skills

Are there any special skills you have that might benefit Rebuilding Together Omaha?
Are you great at drywall? Do you enjoy photography? Are you a master gardener? Other?


In regard to our activities on Rebuilding Day, would you consider yourself:


Gender



Are you a veteran?



Which of the following best represents your racial or ethnic heritage?








Rebuilding Together Omaha Updates

Would you like to receive Rebuilding Together Omaha e-Newsletter?



T-Shirt Size *





Team Information

Team Name or Company Name *

Team Captain *

Emergency Contact

Who should we contact in case of an emergency?

Emergency contact name *


Emergency contact phone number *

Volunteer Waiver

In consideration of being permitted to participate in Rebuilding Together Omaha's National Rebuilding Day on April 29, 2017 and the immediate surrounding work days (hereafter, “Rebuilding Day”), I hereby stipulate and agree for me and my spouse, children, personal representative(s), heirs, estate, successors and assigns as follows:
I hereby fully and forever discharge and release Rebuilding Together Omaha and its agents, employees, representatives, administrators, officers, directors, volunteers, parents, subsidiaries, affiliated companies, predecessors, successors, trustees, insurers and sponsors, as well as all other participants and volunteers in the said Rebuilding Day, from any and all liability, claims, demands, actions and causes of action whatsoever (including that liability and those claims, demands, actions and causes of action that now exist or may hereafter accrue) arising out of or relating in any way to any accidents, incidents, occurrences, casualty, events, damages, injuries, costs, losses and expenses as a result of or in connection with my participation in any way whatsoever in the Rebuilding Day, including, but not limited to, my participation in any way whatsoever in any activities, construction, events, labor, repair and/or work occurring on, preceding and/or anteceding the Rebuilding Day.

I further fully agree, promise and covenant not to sue Rebuilding Together Omaha and its agents, employees, representatives, administrators, officers, directors, volunteers, parents, subsidiaries, affiliated companies, predecessors, successors, trustees, insurers and sponsors, as well as all other participants and volunteers in the said Rebuilding Day, for any all liability, claims, demands, actions and causes of action whatsoever (including that liability and those claims, demands, actions and causes of action that now exist or may hereafter accrue) arising out of any accidents, incidents, occurrences, casualty, events, damages, injuries, costs, losses and expenses as a result of or in connection with my participation in any way whatsoever in the Rebuilding Day, including, but not limited to, my participation in any way whatsoever in any activities, construction, events, labor, repair and/or work occurring on, preceding and/or anteceding the Rebuilding Day.

I agree to indemnify and hold harmless Rebuilding Together Omaha and its agents, employees, representatives, administrators, officers, directors, volunteers, parents, subsidiaries, affiliated companies, predecessors, successors, trustees, insurers and sponsors against any and all costs, damages, expenses, losses and attorney fees from any claims, demands, actions and causes of action of any kind whatsoever that are, have been in the past or may be in the future asserted by me and/or my spouse, children, personal representative(s), heirs, estate, successors and assigns as a result of or in connection with my participation in any way whatsoever in the Rebuilding Day, including, but not limited to, my participation in any way whatsoever in any activities, construction, events, labor, repair and/or work occurring on, preceding and/or anteceding the Rebuilding Day.

I UNDERSTAND AND AGREE THAT MY PARTICIPATION IN ANY WAY WHATSOEVER IN THE REBUILDING DAY OR MY PARTICIPATION IN ANY WAY WHATSOEVER IN ANY ACTIVITIES, CONSTRUCTION, EVENTS, LABOR, REPAIR AND/OR WORK OCCURRING ON, PRECEDING AND/OR ANTECEDING THE REBUILDING DAY INVOLVES INHERENT, UNPREDICTABLE AND UNAVOIDABLE DANGERS, HAZARDS AND RISKS, INCLUDING, BUT NOT LIMITED TO, PERSONAL INJURIES, PERMANENT DISABILITY, PARALYSIS AND DEATH. THESE DANGERS, HAZARDS, RISKS AND INJURIES MAY BE CAUSED BY THE ACTIONS OR INACTIONS OF ME, OTHER PARTICIPANTS IN THE REBUILDING DAY, THE HOMEOWNER OR BY ANY OTHER PEOPLE. I UNDERSTAND AND AGREE THAT I AM ASSUMING ALL RISKS OF PARTICIPATING IN ANY WAY WHATSOEVER IN THE REBUILDING DAY AND ANY ACTIVITIES, CONSTRUCTION, EVENTS, LABOR, REPAIR AND/OR WORK OCCURRING ON, PRECEDING AND/OR ANTECEDING THE REBUILDING DAY.

I agree that Rebuilding Together Omaha may use images, recordings or any other types of reproductions of me as a result of or in connection with my participation in the Rebuilding Day for its business, commercial and/or promotional purposes. I grant Rebuilding Together Omaha the right of publicity to own and use any images, recordings or any other types of reproductions of me as a result of or in connection with my participation in the Rebuilding Day. In addition, I grant Rebuilding Together Omaha full permission to copyright, use and publish any images, recordings or any other types of reproductions of me for publication, promotional and any other business purposes of Rebuilding Together Omaha. I also agree that any images, recordings or any other types of reproductions of me that Rebuilding Together Omaha uses for its business, commercial and/or promotional purposes belongs to Rebuilding Together Omaha as its sole property.

I declare that I am over the age of 18, that I am of sound mind and body and that I am voluntarily electing to participate in the Rebuilding Day, including, but not limited to, my participation in any way whatsoever in any activities, construction, events, labor, repair and/or work occurring on, preceding and/or anteceding the Rebuilding Day. I agree that no oral representations, statements or inducements of any kind apart from the foregoing provisions of this Release, Waiver and Covenant not to Sue have been made to me or anyone else. I acknowledge and declare that I have read, understand and am voluntarily executing my signature on this Release, Waiver and Covenant not to Sue.

Authorization for Volunteering *

Please type your full name below as agreement to the Rebuilding Together Omaha volunteer waiver.
We will also ask you to sign this form in-person at volunteer check-in the morning of Rebuilding Day.


Age *

If 18 or under, we will request a parent or guardian to provide authorization for volunteering.



Guardian name for 18 and younger.*


Guardian phone number for 18 and younger.*


Please enter your first and last name below.
First name:
Last name:
Email address: