VOLUNTEER GUILD: Information, Registration and Informed Consent Form

The Claude Moore Colonial Farm is always seeking volunteers. Please fill out and submit the form below. PLEASE NOTE: It is each volunteer's responsibility to contact the Farm to set up date(s) to volunteer. Submitting the form below does NOT sign you up for a volunteer day; it provides the Farm with the information we need to have on file for each volunteer. Thank you!

Your Contact Information

* First Name

* Last Name

* Address 1

Address 2

* City

* State

* Postal Code

* Primary Phone

Secondary Phone

* Email Address

* Date of Birth

Participating Family Members (and ages, if under 18):

Emergency Medical Information

* Emergency Contact Name:

* Phone Number

Alternate Phone Number

* Are you restricted from performing any physical activities?

No

Yes

* Are you currently taking any medications?

No

Yes

* Date of last tetanus shot:

Volunteer Interests

What days of the week are you consistently available?

What areas of work would you be interested in (check all that apply)?

Comments/Additional Information

Informed Consent

* By typing in my full name I certify that I have read, understand and agree to the conditions in the Informed Consent located below:

I wish to volunteer my services (or approve my child doing the same) to The Claude Moore Colonial Farm at Turkey Run, Inc. (the Farm). I understand the nature of the volunteer activities that are to be performed by me or my child may involve physical activity, contact with unidentified and unfamiliar persons, tools and equipment as well as farm animals and may involve other potential risks of injury.

Knowing this, I still wish to volunteer and hereby assume the risk, with respect to any liability of the Farm for such risks of any accident or injury to person or property, which I or my child may sustain in connection with my (his/her) participation as a Farm volunteer. In addition, I hereby release and discharge the Farm and all of its directors, officers, employees, partners, affiliates, agents or successors from any and all liability or responsibility for any such accident or injury. I have (or my child has) health insurance coverage, which would cover any accident or illness, and I understand that the Farm will not be responsible for any medical expenses, which I may incur as the result of my activities as a Farm volunteer. Furthermore, failure to disclose medical conditions and/or prescribed medications before volunteering can be grounds for dismissal from any program and the Farm grounds.

Understanding that the Farm is an organization involved in providing educational programs to adults and children, I hereby affirm that I have never been convicted of a violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape or any sexual offense, nor have I been ordered by a court to receive psychiatric or psychological treatment in connection therewith.

I understand that failure to cooperate with the Farm staff and abide by the rules and standards of the park will result in forfeiture of the right to participate as a Volunteer of the Farm. I recognize that children must remain with their parent/guardian or their supervising adults at all times while on Farm property. I authorize the non-commercial use of any photographs, film, recording or video tape to publicize the Farm.

* Today's Date

If participating youth is under 18:
I concur that my child, who has signed above, may participate as a volunteer at the Farm in accordance with the Informed Consent located below this form on the website of the Claude Moore Colonial Farm www.1771.org and I waive any claim which I might have as a parent/guardian on behalf of such child against the Farm, its directors, officers, employees, partners, affiliates, agents or successors. NAME OF PARENT OR GUARDIAN:

* Indicates Response Required