Volunteer Registration | Miracle Tree of Lagrange County

1. Personal Information

First Name*

Middle Initial

Last Name*

Previous Names / Maiden Name

Current Address*

City*

State of Residence*

Zip Code*

Phone Number*

Email Address*

Days & Hours Available to Volunteer*

2. Emergency Contacts

Primary Emergency Contact

Name*

Relationship*

Phone Number*

Email Address

Address

Secondary Emergency Contact (Optional)

Name

Phone Number

3. Verification & Criminal History Consent

Verification of Identity*

Please supply a photocopy of a government-issued photo ID (driver's license or passport).

Criminal History Consent Form

Required of all candidates for "volunteer positions" (LaGrange County Miracle Tree INC. / LaGrange/Steuben County Toys for Tots)

I hereby authorize the LaGrange County Miracle Tree INC. Program and its affiliates to conduct criminal history checks on me.

I understand that selection into any program by the program is contingent upon a review of my criminal background to determine my eligibility for any program.
I understand that I will be given an opportunity to review and challenge the factual accuracy of a result before action is taken to exclude me from any program volunteer position.
I understand that any information relating to criminal history checks will be kept confidential and will only be shared with the program board of directors.
I understand that I am ineligible to serve in a position for the following reasons: I refuse to consent to the Criminal History Check Consent Form; I am registered, or required to be registered, as a sex offender; I have been convicted of murder; I have been convicted of theft; I make a false statement in connection with the inquiry concerning my criminal history.
I understand that based upon aspects of Lagrange County Miracle Tree INC, other convictions may be taken into consideration when determining if an applicant is disqualified from participation.

I have read, understand, and consent to the Criminal History check as outlined above.*

4. Legal Agreements & Waivers

Facility Use Agreement

Daniel Lehman (hereafter "Owner"), Private Individual makes his facilities available to LaGrange County Miracle Tree INC for meetings or other events/services, as per agreement.

GENERAL GUIDELINES AND REQUIREMENTS

For purposes of this Agreement, any reference to facilities includes reference to any property of the Owner, including furniture and equipment.
User is required to abide by all Owner guidelines, requirements, and other restrictions regarding usage of the facility.
Owner reserves the right to schedule other activities and events in other parts of the facility on the same date(s) and time(s).

TERMS AND CONDITIONS

User agrees that it will not use the facility for any unlawful purpose and will obey all laws, rules, regulations of all governmental authorities.
User agrees that it will not use the facility for any purpose that is contrary to the mission, purpose or belief of the Owner.
User agrees to be responsible for preparing for use and returning to the pre-use condition all areas of the premises which User will use.
User agrees to conduct a visual inspection of the premises prior to each use, and warrants that the premises will be used only if it is in a safe condition.
User agrees to hold harmless, indemnify and defend Owner from any and all liability for injury or damage.
User agrees to acquire adequate insurance to cover any injury or damage (Personal auto/medical).
In the event of damage to Owner's facility, those using any Owner's facility shall accept the amount of repair and replacement costs.
Neither party is liable for any failure of performance if such failure is due to Force Majeure.
This Agreement is non-exclusive.
Both parties claim independence from one another.
Either party's failure to enforce any provision shall not be construed as a future waiver.
Severability applies to this agreement.
This Agreement sets forth the entire agreement and understanding between the parties.

I have read, understand, and agree to the Facility Use Agreement.*

Non-Disclosure Agreement (NDA)

This Nondisclosure Agreement (the "Agreement") is entered into by and between LaGrange County Miracle Tree ("LCMT") and the Volunteer.

Definition of Confidential Information. "Confidential Information" shall include any and all information or material, written or orally provided, that has or could have commercial value or other utility in the business in which LCMT is engaged. All information relating to LCMT is considered confidential.
Exclusions. The Volunteer's obligations do not extend to information that is publicly known, learned through legitimate outside means, or disclosed with prior written approval.
Obligations of Volunteer. Volunteer shall hold and maintain the Confidential Information in strictest confidence for the sole and exclusive benefit of LCMT. Volunteer shall return to LCMT any and all records IMMEDIATELY if requested.
Time Periods. The nondisclosure provisions shall survive the termination of this Agreement.
Relationships. Nothing contained in this Agreement shall be deemed to constitute either party a partner, joint venture or employee of the other party.
Severability & Integration. If a court finds any provision invalid, the remainder shall be interpreted to affect intent. This Agreement expresses the complete understanding of the parties.
Notice of Immunity. An individual shall not be held criminally or civilly liable under any federal or state trade secret law for the disclosure of a trade secret made in confidence to a government official or attorney solely to report a suspected violation of law.

I have read, understand, and agree to the Non-Disclosure Agreement.*

Marine Toys for Tots Foundation Waiver

Waiver, Release and Hold Harmless Agreement

In consideration of permission granted by the Marine Toys for Tots Foundation ("Foundation") allowing me to participate as a Toys for Tots Volunteer during the Marine Corps Reserve Toys for Tots Program National Campaign (the "Activity"), which will occur from 1 January through 30 March, I represent and agree as follows:

I acknowledge that participating involves certain risks. I accept and voluntarily incur all risks of any injury, damage, loss or harm to me which arises during or results from my participation.
I acknowledge that should I operate my personal vehicle, it is my duty to have a current personal auto insurance policy which must provide for bodily injury, property damage, and physical damage liability. My insurance is primary & non-contributory.
I expressly hold harmless the Released Parties from all losses, liabilities, damages, costs or expenses incurred as a result of any claims arising from the operation of my personal vehicle.
Prior to participating, I affirm that within the past fourteen (14) days, I have not been diagnosed with, demonstrated symptoms of, nor been exposed to communicable diseases (including COVID-19). I acknowledge risks of exposure to communicable diseases by participating.
I also waive all claims against any of the Released Parties for any injury, damage, loss or harm to me, whether known and unknown.
I further agree to indemnify and hold the Released Parties harmless from all losses and litigation costs incurred as a result of claims or suits I may bring against them.
I have carefully read and reviewed this Waiver, Release and Hold Harmless Agreement. I understand it fully and I execute it voluntarily.

I have read, understand, and agree to the Marine Toys for Tots Waiver, Release and Hold Harmless Agreement.*

5. Final Signatures & Submission

By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.

Volunteer Signature*

Date Signed*

If Volunteer is under the age of 18, Parent or Guardian must also sign:

Parent/Guardian Signature

Parent/Guardian Name (Printed)

Volunteer Registration Packet