Mission Outreach – Volunteer Registration

21Dec
To be completed by each participant and submitted by May 15, 2022.
Mission Outreach - Volunteer Registration
MISSION OUTREACH - VOLUNTEER REGISTRATION
Participated with HRLC before?
Address
Address
City
State/Province
Zip/Postal
Can you receive text messages on this phone?

EMERGENCY MEDICAL INFORMATION
Medical information on this form will remain confidential and will only be used if medical treatment is needed. It will be used for no
other purpose.

Have you had a Tetanus shot?
If yes, how recent?
If this does not apply, please type in 'none'
If this does not apply, please type in 'none'
If this does not apply, please type in 'none'
MEDIA RELEASE
I hereby grant permission to Hinton Rural Life Center to use photographs, videos, social media posts, and/or any other media of me/my dependent for promotion and publicity purposes. Permission is granted for the use requested.

**If permission is not granted, it is the responsibility of the Group Leader to inform Hinton staff verbally upon arrival.

***IF VOLUNTEER IS UNDER 18 YEARS OF AGE:

Also at Hinton?
Also at Hinton?

PLEASE BRING A COPY OF YOUR INSURANCE CARD WITH THIS DOCUMENT AND KEEP A COPY OF THIS FORM IN THE VEHICLE WITH THE PARTICIPANT AT ALL TIMES.