Please take a few minutes to tell us about yourself & how you can help in the event of an emergency. Click SUBMIT when you are ready to send, or RESET to start over (these buttons are located at the bottom of this form).

Name:     Address:       e-mail:     City:       Phone(s):     State:   Maryland Virginia Washington, DC Delaware (other)     Occupation:     ZIP:

Additional Information as to your skills & your ability to help in an emergency:

Volunteer's Waiver, Assumption of Risk, & Informed Consent   I wish to volunteer my services to various community service organizations. I understand that the nature of the volunteer activities which are typically performed by volunteers, and which may be performed by me as a volunteer, may involve physical activities, contact with unidentified and unfamiliar persons & foreign and unidentified substances, travel to and from various unspecified locations, and other potential risks of injury. Knowing this, I still wish to volunteer and hereby assume the risk with respect to any liability of the Volunteer Center for Anne Arundel County (hereafter "VCAAC") for such risks of any accident or injury to person or property which I may sustain in connection with my participation as a volunteer or in any VCAAC-related activity. In addition, I hereby release and discharge the VCAAC and any of its directors, officers, employees, partners, affiliates, agents, and successors from any and all liability or responsibility for any such accident or injury. I agree that I will only perform volunteer activities that I am comfortable doing. Understanding that the VCAAC is an organization involved in referring potential volunteers to organizations involved with child care and other related matters, I hereby affirm that I never been convicted of a violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape, or any sexual offense, nor have I ever been ordered by any court to receive psychiatric or psychological treatment in connection therewith. I grant full permission for the VCAAC to use photographs of me and quotations from me in legitimate accounts and promotions of projects. By submitting this form, the sender consents to the release of his or her name, address and contact information. If you do not agree, please click on "Reset" below.