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Full Name *

Email Address *

I am affiliated with * (school, program, company)

Group Leader Name

Client's Address/Place of Service (if known)

Waiver Agreement

I certify that I do not have a history of violent crime within the last 5 years.

I acknowledge the potential risk involved in volunteering and will not hold Eras Senior Network liable in the event of an accident.

I agree to have my photo taken during the service opportunity.

I recognize that I am expected to adhere to relevant COVID-19 precautions including wearing a mask, social distancing when possible, and sanitizing any spaces clients may touch.

If volunteer is under 18, I certify that I am a legal guardian/parent signing on behalf of a youth volunteer.

I understand that I am serving a vulnerable population and will make every effort to respect their dignity, privacy, and interact with integrity.

Type Your Name for Signature *

Today's Date *