Cleanup Volunteer Registration Form

Cemetery Ministry Sign-Up

Help maintain our beautiful St. Mary of the Lake Cemetery. Participate whenever you have the time to stop by to pick up trash, rake leaves, pull weeds, etc.
Full Name

First NameLast Name
Phone
Format: (000) 000-0000.
E-mail
example@example.com
ADULT LIABILITY WAIVER

Each adult participant, volunteer, driver, group leader and chaperone, must sign this form
Parish/School: St. Mary of the Lake Church
Nature of Activity: Cemetery Volunteer
Date: variable
Duration: variable

RELEASE OF LIABILITY, INDEMNIFICATION AGREEMENT & MEDICAL RELEASE

I, _{fullName}__, agree on behalf of myself, my heirs, assigns, executors, and personal representatives, to hold harmless, and defend St. Mary of the Lake Church, the Archdiocese of Saint Paul and Minneapolis, its officers, directors, agents, employees and representatives ("Releasees") associated with the Activity from any and all liability claims, injury, loss and damage arising from or in connection with my participation in the Activity.

Further, I AGREE to hold Releasees harmless and indemnify Releasees for any claim or cause of action whatsoever, including but not limited to all claims relating to communicable disease, arising out of the above Activity which takes place during the above identified dates that is brought against Releasees by myself or my family members, heirs, assigns, executors, and personal representatives.

I UNDERSTAND that participation in the described activity involves danger and risk of injury. The inherent danger is understood and voluntarily assumed.
EMERGENCY MEDICAL TREATMENT: If I should require medical treatment and I am not able to communicate my desires to attending physicians or other medical personnel, I give permission for the necessary emergency treatment to be administered. Please advise the doctors that I have the following allergies and/or other health conditions:
In case of an emergency and for permission for treatment beyond emergency procedures, please contact:
Name

First NameLast Name
Relationship to me
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Health Insurance Carrier
Insurance ID Number
Insurance Policy Number
I HAVE READ THIS DOCUMENT. I UNDERSTAND IT IS AN AUTHORIZATION FOR MEDICAL TREATMENT, INDEMNIFICATION AGREEMENT AND RELEASE OF ALL CLAIMS. I UNDERSTAND I ASSUME ALL RISK INHERENT IN THIS ACTIVITY. I VOLUNTARILY SIGN MY NAME EVIDENCING MY ACCEPTANCE OF THESE PROVISIONS.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Cemetery Ministry Sign-Up

ADULT LIABILITY WAIVER