| Your Personal Information |
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First Name *
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Last Name *
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Address *
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City *
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State *
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Zip Code *
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Home Phone *
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Cell Phone
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Work Phone
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Email *
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| Preferred Contact Time: |
Phone Morning Phone Evening Email |
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| Have you ever been convicted of a felony? Yes No |
If yes please explain:
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| Marital Status |
Single Married Divorced Other |
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Spouse First Name
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Spouse Last Name
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Spouse Address Same as Above?
If no, please enter the information below |
Yes No |
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Spouse Address
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Spouse City
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Spouse State
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Spouse Zip Code
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Spouse Phone
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Spouse Email
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| Your Emergency Information |
Contact Name *
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Relationship *
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Daytime Phone *
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Evening Phone *
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Physician Name
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Training or Interests:
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| Languages (Please list below) |
Speak ReadWrite |
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| Mornings (9-12)
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Afternoon (12-5)
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Weekly
Yes No |
Hours per Week
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Monthly
Yes No |
Hours per Month
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| Please Mark the Volunteer Opportunities that Interest You |
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| Will you need special accommodations? Yes No |
If yes, Please let us know how we can help you
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Where did you Hear about Memorial Park Conservancy Volunteer Opportunities?
Volunteer Waiver |
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I do hereby agree that I will indemnify and hold harmless the Memorial Park Conservancy, Inc. and Houston Parks & Recreation Department, its officers, agents and assigns, and its members, from any and all liability or claims of injury of whatsoever nature which may be incurred by me as a result of my voluntary participation in the project sponsored by the Memorial Park Conservancy, Inc. and City of Houston Parks and Recreation Department, including but not limited to the following activities.
Possible use of clippers, rakes, hoes or shovels will be needed to assist in the clearing process. Bagging litter and/or debris along designated sites and/or collecting piles of trash and litter to be bagged and transporting debris to collection point.
I further represent and certify to the Memorial Park Conservancy, Inc. and Houston Parks and Recreation Department, its officers, agents and assigns that I am physically able to do the various things enumerated above without limitation, and that I have no disabilities which might prevent me from doing the same.
I certify that either I am eighteen (18) years of age or older, or that my parent or court-appointed guardian has full knowledge of my participation in this event and has given me permission to participate, as evidenced by his/her signature below. |
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Important Instructions:
Print and mail the signed form to:
Memorial Park Conservancy, Inc.
P.O. Box 131024 Houston, TX 77219 |
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| Undersigned has read the above and understands this waiver |
Required Signature
X _____________________________________________________________ |
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After you click "Submit Application", a window will pop-up instructing you to print the form. This completed form is also electronically submitted. | |
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