Name *

First Name

Last Name

Birthday *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Your Phone

(###)

###

####

Emergency Phone

(###)

###

####

Have you volunteered for the Blitz before?

Yes

No

Victory Garden Initiative Permission Slip and Waiver

I hereby agree to participate in the activities, including the construction of raised garden beds, including, but not limited to, digging, lifting, carrying, mulching and moving soil, at properties in the Milwaukee area as part of Victory Garden Initiative Garden Blitz. I understand that my participation in the work with Victory Garden Initiative is completely voluntary. It is my judgment that I am fully capable to participate in “The Blitz” from both a physical and emotional standpoint. I understand that due to the physical activities, some of which are strenuous, there is a risk that I may be injured while participating in the project. I hereby acknowledge that should I sustain an injury or illness in connection with my volunteer activities, I will not be afforded any form of medical insurance or workers’ compensation benefits. I fully understand the type of activities which will be taking place during “The Blitz” and agree with and consent to all of the terms for participation set forth and presented to me at the time of orientation. I agree to release and waive any and all responsibility of Victory Garden Initiative or its officers, agents, or employees, for any accidents or other incidents that may arise out of or occur while I am participating in “The Blitz.” I also understand that I will not be monetarily compensated for any services rendered in connection with the work of “The Blitz.” I agree to release and forever discharge Victory Garden Initiative, their officers, agents, employees and representatives from any and all liability claims or demands that might arise out of or in connection with: 1) any accident, illness, injury or other consequences or event arising from my participation in this project, or 2) any cause beyond the control of Victory Garden Initiative including, but not limited to, natural disasters, civil disturbances, and weather.

I agree

Covid-19 Acknowledgement *

I understand that Victory Garden Initiative has put certain additional safety protocols in place to keep staff, volunteers, and community members safe from Covid-19 pandemic during the Blitz event and agree to follow these instructions. I understand that failure to comply with these protocols may result in my removal from the premises. I understand that there is still a risk that I may be exposed to the disease by my participation and I agree to release and waive any and all responsibility of Victory Garden Initiative or its officers, agents, or employees in that event. I also agree to inform Victory Garden Initiative staff if I should develop Covid-19 symptoms after participating in a volunteer shift so that staff can take appropriate quarantine precautions for anyone you may have come in contact with.

I understand

Media Release

I do hereby grant and convey unto Victory Garden Initiative all rights, title, and interest in any and all photographic images and video or audio recording made by Victory Garden Initiative during my volunteer activities with VGI, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.

I grant media rights