ADULT and Family Volunteer Registration

Medication and Sharps Collection on Saturday, April 27, 2024

Our preference is for parents/guardians or a trusted adult to chaperone all student(s) under 18 years of age. However, if you are not planning to chaperone your student under 18 years of age, please do NOT complete this form. Instead, please register students interested in attending without a chaperone at: https://www.surveymonkey.com/r/Youth4-27-24

Adults and Families Only:
Thank you for volunteering for HC DrugFree's medication and sharps collection scheduled for Saturday, April 27 from 10 a.m. to 2 p.m. (with set up 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's first name

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* 2. Adult's last name

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* 3. Will you be chaperoning your student(s) or member(s) of our Teen Advisory Council?

Yes

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* 4. If bringing student(s), name and grade of student #1

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* 5. If bringing student(s), name and grade of student #2

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* 6. If bringing student(s), name and grade of student #3 or more

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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

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* 12. Phone number for student

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* 13. EXACT time between 9:15 a.m. and 2:15 p.m. that you will volunteer

All day - 9:15 to 2:15 (We encourage volunteers to bring lunch or snacks. Restaurants in plaza. HCDF hopes to provide some snacks/water.

Morning only - 9:15 to noon

Afternoon only - noon to 2:00

Other (please specify exact time)

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* 14. Are you willing to volunteer rain or shine?

Yes

Other (please specify)

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* 15. Are you willing to hold a sign or direct traffic from a safe sidewalk location?

Yes

Other (please specify)

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* 16. Are you able to stand, or if you prefer to sit, will you 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. Do you have medical training to handle medication and sharps?

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 in April. Do you agree?

Yes

No (please specify)

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

Yes

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

By submitting this registration, I agree to this waiver(s):

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.