Volunteer Information and Release Form

Personal Information

Please describe below:

1. Any physical fitness limitations, e.g.: no lifting over 30 lbs, back problems, heart condition, limited sun exposure, allergies, unable to stand / walk long distance, etc.)
2. Any other health issues that we should be aware of or that could impact your work in an assigned volunteer position
3. Medications you are taking — list with reasons

Emergency Contact Information

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