PO Box 53
Frankfort, MI 49635
Phone: 231-399-0300
Email: info@benziehabitat.org

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Volunteer Form

Please complete the Volunteer Form as completely and accurately as possible. Your information will be kept confidential.

Volunteer Form

Contact Information

Address *
Address

Affiliations

Thrivent?

Availability

Times Available *

Areas of Interest

General Areas of Interest *
Please check general areas of interest.
Construction Interests
Optionally, select specific interests.
Committee Work Interests
Optionally, select specific interests.
Miscellaneous Interests
Optionally, select specific interests.
Professional Skills
Optionally, select specific interests.

Emergency Contact Information

Emergency Contact's Relationship to You *
Emergency Contact Address *
Emergency Contact Address
Note: It is your responsibility to notify crew leader each time you work.

Authorization And Release

Liability Release

I hereby release Habitat for Humanity of Benzie County (HFHBC) and any of its associations, including its agents, directors, officers, or workers, from any and all claims, demands, suits, or causes of action against it which I have or may have in the future with regard to any and all accidents, injuries or damages to me or my property arising from work performed on HFHBC projects. I understand that I am a volunteer working on a project and as such waive all rights to claims, demands, suits, or causes of action for injury or damage sustained in relation hereto.

Accident Insurance Coverage

I further understand that HFHBC currently provides Volunteer Accident Medical Insurance Coverage with a $250,000 limit. This coverage is primary coverage insurance for volunteers without personal accident medical insurance and becomes secondary coverage insurance for volunteers with existing personal accident medical insurance coverage subject to all deductibles and policy terms and conditions relating to working as a volunteer on a Habitat for Humanity project.

Confidentiality Agreement

I consciously and willingly promise never to reveal any private or personal information about applicants, homeowners, volunteers, or other members of HFHBC which I become aware of through my participation.

I further state that I have carefully read and understand the foregoing, and sign as my own free act.

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