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ADULT and Family Volunteer Registration

Medication and Sharps Collection on Saturday, October 28, 2023

It is now after 2 pm on Fri, Oct 27, so please complete this registration, but you may not receive any confirmation from us. Please just go to the Volunteer Table tomorrow to sign in. 
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/YouthVolunteer10-28-23
Adults and Families Only:
Thank you for volunteering for HC DrugFree's medication and sharps collection scheduled for Saturday, October 28 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. 
1.Adult's first name(Required.)
2.Adult's last name(Required.)
3.Will you be chaperoning your student(s) or member(s) of our Teen Advisory Council?(Required.)
4.If bringing student(s), name and grade of student #1
5.If bringing student(s), name and grade of student #2
6.If bringing student(s), name and grade of student #3 or more
7.Email address of adult registering(Required.)
8.Re-enter email address(Required.)
9.Phone number of adult(Required.)
10.Re-enter phone number(Required.)
11.EXACT time between 9:15 a.m. and 2:15 p.m. that you will volunteer (Required.)
12.Are you willing to volunteer rain or shine?(Required.)
13.Are you willing to hold a sign or direct traffic from a safe sidewalk location?(Required.)
14.Are you able to stand, or if you prefer to sit, will you provide your own lawn chair? (We will not provide chairs.)(Required.)
15.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?(Required.)
16.If answered YES above and you have medical training, please specify:
17.Volunteers must follow HC DrugFree's guidance and procedures based on CDC or County guidelines in effect in October. Do you agree?(Required.)
18.Volunteers wear HC DrugFree t-shirts. Do you already have our t-shirt?(Required.)
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.
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