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P.R.A.Y. Project Rescue of Amazon Youth
APPLICATION

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Volunteer Application and Waiver

Volunteer Application Form


Name:
Date of Birth:

Home Address:
City:
State:
Zip:
Country:

Home Phone:
Work Phone:
E-Mail address:

Emergency Contact:
Name:
Home Phone:
Work Phone:
Relationship to you:

Do you have any physical limitations or medical conditions that would prevent you from safely doing the taks you are applying for?
No_______ Yes_________
if yes describe:


Employment Information:

Company/Agency Name:
Phone:
Address:

Position Title:

Employment Dates: From:___________ To:___________

Supervisor:

Specialties/Responsibilities/Duties/Special Projects:



References: Name Address Phone (list 2)




Interests and Experience:


Education/Licenses/Certificates:


Foreign languages:


When would you be available to go?

What length of time are you interested in staying at P.R.A.Y.?


AGREEMENT AND RELEASE FOR ALL VOLUNTEERS

I am applying for volunteer service for P.R.A.Y. (Project Rescue of Amazon Youth), whose mission is to help children in Northern Brazil who are abandoned, orphaned, or otherwise in need. I certify that all statements made in my application and description of work history are true, accurate and complete. I hereby expressly authorize P.R.A.Y., its Directors, agents and employees, to investigate in any manner they deem appropriate, at their sole discretion, my medical, health, educational, employment, community service or professional background, public or private records including but not limited to law enforcement and court records and personal references. I further consent to and authorize P.R.A.Y. to communicate with any and all of my previous or current employers relating to my work record and experience.

In consideration of being evaluated for volunteer service with P.R.A.Y., I hereby release and forever discharge P.R.A.Y., its Directors, agents and employees from any and all claims, demands, damages or liability relating to or arising out of the requesting of, or furnishing of, any information relating to my medical, health, educational, employment, community service or professional background, public or private records including but not limited to law enforcement and court records and personal references as described above.

In consideration of P.R.A.Y. arranging a volunteer assignment for me, and with the intention of binding myself, my heirs, legal representatives, successors and assigns, I hereby expressly RELEASE AND FOREVER DISCHARGE P.R.A.Y., its directors, employees, volunteers, agents, legal representatives, insurers, successors, and assigns from any and all claims, demands, damages, liabilities, and causes of action that I now have or may in the future have, whether known or unknown, of whatsoever nature, relating to or arising out of my selection as a volunteer by, or my service as a volunteer with P.R.A.Y. whether or not due to P.R.A.Y.s negligence, strict liability, or any other breach or fault. This includes, but is expressly not limited to, death, bodily injury, personal injury, property damage, loss or theft of property, economic loss, or any other damage, loss, or cost.

This document shall be construed according to the laws of the state of Kansas. If a dispute should arise with respect to the meaning of any of the terms of this document, the rule of construction that a document is construed against the party preparing such document shall specifically not be applicable to the interpretation of this document.

This General Release represents the entire agreement of the parties hereto and supersedes any and all prior or contemporaneous oral or written understandings, statements, representations, or promises. All of the terms hereof are contractual and not mere recitals.

I acknowledge that I have carefully read this General Release, know and understand the contents thereof, and that this document was freely and voluntarily executed. I acknowledge that I was given the opportunity to seek independent legal counsel on any and all matters herein before I signed this General Release.

Signature_____________________________

Date_________________________________