Disaster Relief Volunteer Application

Disaster Relief Volunteer Application

The entire form must be completed in one sitting. Exiting the form or refreshing the page will delete any answers already filled in. Once you click the "Submit" button at the bottom, your answers will be sent. If you have any questions regarding this application, please send them to .

Thank you for your interest in volunteering on the Chapel Disaster Relief team. Please provide all applicable information. All information is confidential and will only be shared with appropriate personnel.

Adult Volunteer Release and Waiver of Liability

Code of Conduct

I agree to represent Jesus Christ and Williamsburg Community Chapel (the “Chapel”) in my attitude, behavior, speech, and dress and to demonstrate love and kindness toward one another and those being served, in accordance with the Chapel’s Statement of Faith. I agree to treat each person being served and his/her property with dignity and respect.

Volunteer Status / Insurance

I understand and acknowledge that I am a volunteer, not an employee, of the Chapel or their ministry partners. As a volunteer, I am not entitled to insurance or other benefits from the Chapel. I understand it is my responsibility to provide my own health, disability, or accident insurance to cover my claims or damages from any injury, illness, death, or property damage that may result from performing volunteer work on behalf of the Chapel.

Assumption of Risk / Release of Liability

As a volunteer for the Chapel, I understand that I may engage in hazardous work that involves a risk of illness, physical injury or death, and/or property damage and hereby assume all responsibility for any and all risks associated with this volunteer work. This work may include hard physical labor, heavy lifting, and exposure to environmental hazards. I agree to wear the appropriate protective equipment while volunteering and to follow all instructions of the team leader. I will let my team leader or the Chapel’s staff know of any work I am unable to perform for any reason. I, for myself and my heirs, executors, administrators, and assigns, hereby release, waive and discharge Williamsburg Community Chapel, its directors, officers, employees, agents, and volunteers of and from any and all claims which I or my heirs may have for, on account of, by reason of or arising in connection with such volunteer relief efforts or my participation therein, and hereby waive all such claims, demands, and Updated 8.18.16 causes of action. Further, I expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the Commonwealth of Virginia, and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I currently have no known physical or mental condition that would impair my capability for full participation as intended or expected of me.

Emergency Medical Care and Release

I understand the Chapel will contact emergency medical personnel if I am injured while on a job site and will notify my emergency contact provided on this form. If the Chapel is unable to reach my emergency contact, I do hereby authorize the Chapel, as agent for me, to consent to any x-ray examination; medical, dental, or surgical diagnosis; treatment, and hospital care advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either at a doctor’s office or in any hospital. I do hereby agree to indemnify and hold harmless Williamsburg Community Chapel, its directors, officers, employees, agents, and volunteers from any claim whatsoever on account of such care and treatment. I understand that I remain responsible for any medical bills that may be incurred as a result of any medical treatment administered me and agree to reimburse the Chapel for any expenses related to and in connection with such treatment.

Ministry Photographs and Video

As a volunteer, I agree to have sensitivity to homeowners when taking personal photographs or videos at a Disaster Relief worksite. I also understand, acknowledge, and agree that while volunteering with Williamsburg Community Chapel, my activities may be photographed or videotaped. I consent to the use by the Chapel and/or its authorized representative of photographs or videos in which I appear, and I acknowledge and agree that I have no ownership rights in or to those photographs or videos.

Disaster Relief Volunteer Application

Contact Information

Address*

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Gender*

Emergency Contact Information

Address*

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Family Information
Marital Status*

Health Information

All information in this section will remain confidential and will only be reviewed by the Williamsburg
Community Chapel.

Rate Your Health*

Has there been a change in your health within the last year?*

Are you taking any drugs or medications that can affect your ability to drive a car or operate machinery?*

If yes, it will be your responsibility to decline participation in any disaster relief mission that may endanger you or others around you.

Skills Assessment

Can you lift and handle 50 lbs. or more?*