Lifting Up Lives Volunteer Waiver

Volunteer Waiver

The following form must be completed prior to participating in any LUL activities/events. All fields are required.
Participant Eligibility Requirements*	I am at least 18 yrs of age    I agree to complete appropriate paperwork, have a phone/in-person        interview and attend an orientation   I agree to commit to a volunteer schedule appropriate for my       situation and the current needs of LUL  Check the boxes above to indicate that you agree to the indicated participant requirements
Name*	First Last
Address*	Street Address Address Line 2 City State / Province / Region Postal / Zip Code Antigua and BarbudaAruba,BahamasBarbadosBelizeCanadaCook IslandsCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNetherlands AntillesNicaraguaPanama Puerto Rico Saint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColombiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFaroe IslandsFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorHong KongIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPalestinePhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosDemocratic Republic of the CongoRepublic of the CongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGibraltarGuineaGuinea-BissauCote d'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandUnited Republic of TanzaniaTogoTunisiaUgandaZambiaZimbabwe Country Please complete full address above
Phone Number*	- -
Best Days For You to Exercise*	Monday   Tuesday   Wednesday   Thursday   Friday   Saturday  Mark the best 3 days
Best Times For You to Exercise*	Early Morning 5-8am   Morning 8-11am   Mid-day 11am-1pm   Afternoon 1-4pm   Evening 4-8pm   Late Evening 8-11pm  Mark the best 2 time periods
Your Exercise Experience and Attitude Toward Exercise*
What do you want to accomplish by exercising?*
Do you have any physical injuries, illnesses or limitations that we should be aware of?*	YesNo
Provide Details if you answered yes above
Liability Waiver*	Yes I agree to the below terms and conditions  This form must be signed and dated BEFORE participating in a class. 1.  Voluntary Participation: As a Lifting Up Lives program (herein after LULP) volunteer, I have voluntarily chosen to participate in the classes and activities offered by LULP and that I am under no obligation to continue with such classes and activities. However, should I choose to volunteer (beyond the 2 week trial) I must commit to a schedule of involvement appropriate to my situation. The LULP is not a drop-in program and does require commitment should you voluntarily choose to participate.   2. Assumption of Risk: I am fully aware that fitness programs  require physical exertion which may be strenuous and may cause physical injury, both major and minor. I voluntarily assume full responsibility for any risks, injuries or damages, known or unknown, involved with fitness classes and activities provided by LULP. I understand that I am strongly advised to consult with a physician prior to and regarding my participation and to obtain comprehensive medical insurance prior to engaging in LULP.   3. Release: In consideration of the opportunity afforded me to participate in the LULP, I am waiving the right to file any claim or lawsuit against LULP, its employees, members, officers, directors, agents or representatives for any injury or damage resulting from my participation in this fitness training or all related activities, including, but not limited to, claim of injury, damage to facility, equipment, supervision, including negligence or acts of omission by LULP, its employees, members, officers, directors, agents or representatives.   4.  Knowing and Voluntary Execution: I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a promise not to sue LULP or its employees, members, officers, directors, agents or representatives and I sign this agreement of my own free will. I understand that LULP has the right to refuse services and classes to any individual at anytime.   5. Consent to Photograph and Videotape: I hereby  irrevocably consent to, and authorize the use and  reproduction by LULP of any photographs, recordings,  videotapes and/or other reproductions which have been  secured by or for Lifting Up Lives for promotional purposes conducted by means of publication, print ad, direct-mail piece, electronic media or any other lawful form of promotion.   6. Integrated Agreement: This Liability agreement supersedes and replaces all previous agreements between parties concerning this event, whether written or oral. Checking the box above acts the same as a signature.
Date*	MM / DD / YYYY
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