NW Association for Blind Athletes

Contact Information

Country*
State / Province*
Address*
City*
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Email*
Confirm Email*
Cell Phone*
Home Phone Number
Date of Birth*
Specific activities you would like to volunteer for
Any Medical information information we should be aware about? (Please describe below)
Dietary Restrictions

Emergency Contact Information

Emergency Contact Name*
Relationship*
Phone*

Waiver

I authorize and give consent for the above named organization to obtain information regarding

myself. This includes the following:

Local & National Criminal background records/information

All 50 State Sex Offender Registries

Full Address Trace

Social Security Verification

I, the undersigned, authorize this information to be obtained either in writing or via telephone in connection with my application. Any person, firm or organization providing information or records in accordance with this authorization is released from any and all claims of liability for compliance. Such information will be held in confidence in accordance with the organization’s guidelines.

A criminal report may be obtained at any time after receipt of your authorization and, if you are approved, throughout your volunteering.

By signing this volunteer registration application, the participant affirms having understood all terms and conditions. In consideration of my involvement under the auspices of Northwest Association for Blind Athletes (NWABA) at training and competition sites, I acknowledge and agree to the following: 1.I risk bodily injury, including paralysis, dismemberment and death as well as loss or damage to property; 2. I knowingly and freely assume all such risk; 3. I hereby authorize and give my full consent to NWABA to copyright and/or publish any and all photographs, videotapes and/or film in which I appear while attending any NWABA event. I further agree that Northwest Association for Blind Athletes (NWABA) may transfer, use or cause to be used these photographs, videotapes or films for any exhibitions, public displays, publications, commercials, art and advertising purposes and television programs without limitations or reservations; and 4. I, for myself and on behalf of my heirs, assigns and next of kin, hereby release, hold harmless and promise not to sue the Northwest Association for Blind Athletes (NWABA), their officers, officials, volunteers, agents and/or employees, with respect to any such injury, paralysis, dismemberment, death and/or loss or damage to property except that which is the result of gross negligence and/or wanton misconduct.

For volunteers of minority age - (under 18 at time of registration), this is to certify that I, as a parent/guardian of this participant, consent to his/her release of the Northwest Association for Blind Athletes (NWABA) from any and all liabilities incident to his/her involvement in the programs conducted at authorized training and competition sites.

If you are unable to fill out this waiver portion online you may do so at the event or email a signed copy of this form to kpomeroy@nwaba.org. Filling out this form to the best of your ability is still required.

 
 
 
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  • Submitting this application attests to an agreement to this waiver
Signature

We will call you for your social security number as it is required to perform a background check.

 
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