Volunteer Registration: Meds & Sharps Take Back (4-26-25)

Saturday, April 26, 2025

Must be over 18 to complete this registration. Our preference is for parents/guardians or a trusted adult to chaperone all student(s) under 18 years of age. If you do not plan to chaperone your HoCo student under age 18, please complete the registration and we will contact you if we have any questions. Thank you.

Thank you for volunteering for HC DrugFree's medication and sharps collection scheduled for Saturday, April 26 from 10 a.m. to 2 p.m. (with set up at 9:15 a.m. and cleanup from 2:00 to 2:15 p.m.). Rain or shine, this is an outdoor event in the Wilde Lake Village Center parking lot.

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* 1. Adult/Parent/Guardian First Name

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* 2. Adult/Parent/Guardian Last Name

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* 3. Will you be chaperoning a student(s)?

I am registering myself only (everyone 18 and older must complete their own registration because of the waiver below)

Yes, I will chaperone my student(s)

No, I will not chaperone my student(s) and they are mature/responsible enough to attend on their own without an adult

Other (please specify)

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* 4. If registering student(s), first and last name and grade of student #1

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* 5. If registering student(s), first and last name and grade of student #2

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* 6. If registering student(s), first and last name and grade of student #3

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* 7. Email address of adult registering

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* 8. Re-enter email address

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* 9. Phone number of adult

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* 10. Re-enter phone number

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* 11. Email address for student if you want us to send reminders to them too

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* 12. Phone number for student in case of emergency or last minute updates

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* 13. EXACT time between 9:15 a.m. and 2:15 p.m. that you or your student(s) will volunteer (We encourage volunteers to bring lunch or snacks, and there are restaurants in plaza.)

All day - 9:15 to 2:15

Morning only - 9:15 to noon

Afternoon only - noon to 2:15

Other (please specify exact time)

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* 14. Willing to volunteer rain or shine?

Yes

Other (please specify)

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* 15. Willing to hold a sign or direct traffic from a safe sidewalk location?

Yes

Other (please specify)

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* 16. Able to stand or provide your own lawn chair? (We will not provide chairs.)

Yes

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* 17. Most volunteers will not handle medication and sharps, but we are looking for trained volunteers to assist. Are you registering as a medically-trained volunteer.

Yes

No (now skip to question #19)

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* 18. If answered YES above and you have medical training, please specify:

Doctor

Nurse

Pharmacist

EMT

Other (please specify)

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* 19. Volunteers must follow HC DrugFree's guidance and procedures based on CDC or County guidelines in effect at the time of the event.

Yes, I agree

If not, please explain:

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* 20. Volunteers wear HC DrugFree t-shirts. Do you already have our green t-shirt?

Yes

If no, what size in case we can provide them?

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* 21. Adults/Parents/Guardians must give consent:

I have read this waiver and knowing the facts, I, for myself and anyone entitled to act on my behalf, waive and release HC DrugFree and its employees, directors, officers, partners, agents, and sponsors from and against all claims, demands or causes of actions for accidents, personal injury, bodily injury, death, property damage or other injury or loss or damage of any kind, occurring from any cause arising from or related to or in connection with named participant’s involvement in the event named above.

Further, I grant permission to all of the foregoing to use named participant’s photographs, audio and audio visual recordings or any other record of this event for any legitimate purpose.

Additional waiver for volunteers handling sharps & medication:
In addition to above, I understand proper handling of meds and sharps, agree to wear provided gloves and protective items, and assume the risk of picking up medications and sharps and placing them in the proper bins. I will decide the appropriate medical care for such, and I understand that it is my responsibility to IMMEDIATELY report any injury (splash, needle stick, cut, etc.) to HC DrugFree’s Executive Director or Board Member present at this event.

Yes, I agree to the above waiver.