Hands On Coastal Georgia

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	Be The Change. Volunteer.

Welcome to the Hands On Coastal Georgia Member Registration.

Use the form below to register as a volunteer for Hands On Coastal Georgia projects, courses, and special events.

* denotes a required field

Member Registration Form

First Name *
Last Name *
Date of Birth *
	mm/dd/yyyy
We require date of birth for verification of eligibility with affiliate projects/activities and for demographic reporting for funders.

Mailing Address *
Address Line 1 *
Address Line 2
City *
State *
Zip code *
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Main Phone Number *		Type*
Other Phone Number		Type

Place of Employment

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Terms and Conditions

HANDS ON COASTAL GEORGIA VOLUNTEER AGREEMENT AND RELEASE  

In connection with my voluntary involvement in activities undertaken for and with the participation and support
of Hands On Coastal Georgia, a non-profit charitable organization, I hereby agree  for myself, my heirs, assigns,
executors, and administrators to release and discharge Hands On Coastal Georgia, its officers, and directors,
employees, agents, and volunteers from all claims, demands, and actions for injuries sustained to my person and/or
property as a result of my involvement in such activities  whether or not resulting from negligence and I agree to
release and hold Hands On Coastal Georgia  its officers, and directors, employees, agents, and volunteers harmless
from any cause, or action, claim, or suit arising therewith.  I hereby attest that my attendance and involvement
in such activities is voluntary that I am participating at my own risk and that I have read the foregoing terms
and conditions of this release.  Furthermore I grant permission for photographs, video, and quotations from me
during my involvement with Hands On Coastal Georgia to be used to further promote volunteerism. I hereby confirm,
represent, and warrant that I have never been convicted of or charged with a violent crime, child abuse, or neglect
child pornography, child abduction, kidnapping, rape, or any sexual offense; nor have I ever been ordered by a court
to receive psychiatric or psychological treatment in connection therewith.

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	Hands On Coastal Georgia 1311 Union Street • Brunswick, GA 31520 Phone: 912 265 1850 • Fax: 912 265 1855

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