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*

Date of Birth*

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 of Identity

Verification of Identity*

Required. Upload a government-issued photo ID (driver's license or passport).

Not attached yet

0 / 2 files · Max 2 files. Phone photos work best.

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 is contingent upon a review of my criminal background.
I understand that I will be given an opportunity to review and challenge the factual accuracy of a result before action is taken.
I understand that criminal history information will be kept confidential and shared only with the board of directors.
I understand I am ineligible if I refuse consent; I am a registered sex offender; I have been convicted of murder or theft; or I make a false statement.
I understand other convictions may be considered when determining eligibility.

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.

TERMS AND CONDITIONS

User will not use the facility for any unlawful purpose and will obey all applicable laws.
User will not use the facility for any purpose contrary to the mission, purpose or belief of the Owner.
User will prepare for use and return to pre-use condition all areas used.
User will inspect the premises before each use and use them only if safe.
User agrees to hold harmless, indemnify and defend Owner from liability for injury or damage.
User agrees to carry adequate personal auto/medical insurance.
User accepts repair and replacement costs for damage to the facility.
Neither party is liable for failure of performance due to Force Majeure.
This Agreement is non-exclusive and is the entire understanding between the parties.

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

Non-Disclosure Agreement (NDA)

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

Confidential Information includes any material that has or could have value or utility in LCMT work. All LCMT information is confidential.
Obligations do not extend to information that is public, learned independently, or disclosed with written approval.
Volunteer shall keep Confidential Information in strict confidence and return records immediately if requested.
Nondisclosure survives the end of this Agreement.
This Agreement does not create a partnership, joint venture, or employment relationship.

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 from the Marine Toys for Tots Foundation allowing participation as a volunteer during the National Campaign (1 January through 30 March), I agree as follows:

I accept the risks of injury, damage, loss or harm arising from participation.
If I operate my personal vehicle, I will carry current auto insurance that is primary and non-contributory.
I hold harmless the Released Parties from claims arising from operation of my personal vehicle.
I affirm I have not been diagnosed with, shown symptoms of, or been exposed to communicable disease, including COVID-19, in the past 14 days.
I waive claims against the Released Parties for injury, damage, loss or harm, known or unknown.
I will indemnify the Released Parties from losses and litigation costs from claims I may bring.
I have read this waiver and execute it voluntarily.

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

5. Final Signatures & Submission

By typing my name below, I agree this electronic signature has the same legal force as a manual signature.

Volunteer Signature*

Date Signed*

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

Parent/Guardian Signature

Parent/Guardian Name (Printed)

Please keep watching your email for updates after you submit.

Volunteer Registration Packet