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Y.E.L.L.
Keep Brazos Beautiful, Inc.
213 B South Main
Bryan, TX 77803
Phone: (979) 775-3569
Fax: (979) 775-3547
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*Note:
All fields marked with an asterisk (*) are required.
*
Event:
Event Date:
*
First Name of Applicant:
*
Last Name of Applicant:
*
Date of Birth:
*
Street Address:
PO Box:
Apt Number:
*
City:
*
State:
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*
Zip Code:
Home Phone Number:
Alternative Phone Number:
*
E-mail:
School Attends:
EMERGENCY CONTACT INFORMATION
*
Emergency Contact Name:
Relationship to applicant:
*
Emergency Contact Phone #:
*
In case of an emergency, does the KBB have your consent to obtain medical services for your child?
Yes
No
Hospital Preference:
*
Does the applicant have health conditions past/present which may be affected by the service needed?
Yes
No
If so, please explain:
*
Has the applicant been convicted of a felony/misdemeanor that prohibits working near minors?
Yes
No
*
Agree to allow KBB and its affiliates to use applicant photograph and name for promotional purposes?
Yes
No
INTERESTS
Please check all that apply. Check marks declare a YES answer.
Interested in volunteering for:
Texas Trash Off
Litter Tackle Box
Texas Recycles Day
Litter Posse
Litter Free Events
Wildflower Campaign
Annual Banquet
Community Tool Shed Program
Annual Tree Sale
Y.E.L.L. (Young Environmental Leaders League)
Arbor Day
For TEXAS TRASH OFF Volunteers Only: T-shirt size (please put an A for adult sizes or Y for Youth in front of the size. Ex: YL for Youth Large)
T-Shirt Size:
DISCLAIMER
By agreeing below, the applicant fully intends to uphold the policies and mission of Keep Brazos Beautiful as an unpaid volunteer.
I agree to complete the duties required within the work shift I have been designated and will notify the appropriate staff person within ample time if I am unable to do so.
I agree there will be zero tolerance on behalf of KBB for any use or influence of alcohol, controlled, or illegal substances while on grounds designated for KBB purposes and events and during volunteer performance. I also agree not to have any such substance in my possession during this time.
I agree to notify KBB designated staff of any concerns I have while participating in the fore mentioned event.
I understand that at any point in time should my behavior become an issue I may be dismissed of my volunteer duties immediately and will be responsible for own transportation.
*
APPLICANT AGREES TO THESE TERMS:
Yes
No
*
Parent/Guardian Name:
I HEREBY CERTIFY THAT AS THE PARENT/CUSTODIAN OF THE APPLICANT THAT THE ABOVE INFORMATION IS ACCURATE. HE/SHE HAS MY PERMISSION TO PARTICIPATE IN THE EVENTS CHECKED OFF. I ALSO HEREBY WAIVE AND RELEASE ANY & ALL CLAIMS FOR DAMAGES THAT MAY ARISE AND/OR FOR ANY TYPE OF INJURIES OR LOSSES INCURRED WHILE PARTICIPATING AND/OR VOLUNTEERING FOR OR IN CONJUNCTION WITH THE ABOVE MENTIONED EVENT.
*
PARENT/GUARDIAN AGREES TO THESE TERMS:
Yes
No
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