Habitat for Humanity of Montgomery and Delaware Counties, PA

Volunteer Application

Volunteers are required to come to an volunteer orientation before they begin volunteering.

West Norriton ReStore:
533 Foundry Road West Norriton PA 19403

Horsham ReStore:
200 Blair Mill Road Horsham PA 19044
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Your information

Required fields are marked with an asterisk (*)
and fill in ALL areas below in it's entirety.
Emergency Contact *
Are you with a group/organization/company? If yes, indicate which below. If no, enter N/A. *
First Name *
Last Name *
Phone Number *
Address *
Emergency Contact # *

A full 10-digit phone number (for example: 555-123-1234, (555) 123-1234, 555.123.1234, etc)
Are you a Veteran *
Is this for Community Service? *
If yes, is it Court Ordered Community Service? *
Birthdate *

A valid date as MM/DD/YYYY (for example: 12/04/1989)
Would you like to sign up for our newsletter? *


Release and Waiver of Liability for 2019
(Participants must sign a waiver prior to taking part in any activity; Please fill out the bolded sections)

This release and waiver of liability executed on
this _______ day of ___________(MONTH), 2019 by ________________________________ (NAME of volunteer – please print)
in favor of Habitat for Humanity International, Inc., a nonprofit corporation, and Habitat for Humanity of Montgomery and Delaware Counties, a nonprofit corporation, their directors, officers, employees, and agents.

The Volunteer desires to work as a volunteer for Habitat and engage in the activities related to being a volunteer. The Volunteer understands that the Activities may include constructing and rehabilitating residential buildings, and working in the Habitat offices.

The Volunteer hereby freely, voluntarily, and without duress executes this Release under the following terms:
1. Release and Waiver: Volunteer does hereby release and forever discharge and hold harmless Habitat and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from
Volunteer’s Activities with Habitat. Volunteer understands that this Release discharges Habitat from any liability or claim that the Volunteer may have against Habitat with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Volunteer’s Activities with Habitat, whether caused by the negligence of Habitat or its officers, directors, employees, or agents or otherwise. Volunteer also understands that Habitat does not assume responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness.
2. Medical Treatment: Volunteer does hereby release and forever discharge Habitat from any claim whatsoever which arises or hereafter may arise on account of any first aid, treatment, or service rendered in connection with the Volunteer’s “Activities with Habitat.
3. Assumption of the risk: The Volunteer understands that the Activities include work that may be hazardous to the Volunteer, including, but not limited to, construction, loading and unloading, and transportation to and from the work sites. Volunteer hereby expressly and specifically assumes the risk of injury or harm in the Activities and releases Habitat from all liability for injury, illness, death, or property damage resulting from the Activities.
I can lift up to 50 lbs (5 gal paint bucket) YES NO
4. Insurance: The Volunteer understands that, except as otherwise agreed to by Habitat in writing, Habitat does not carry or maintain health, medical, or disability insurance coverage for any Volunteer. Each volunteer is expected and encouraged to obtain his or her own medical or health insurance coverage.
5. Photographic Release: Volunteer does hereby grant and convey unto Habitat all right, title, and interest in any and all photographic images and video or audio recordings made by Habitat during the volunteer’s Activities with Habitat, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.
6. Other: Volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Pennsylvania, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Pennsylvania. Volunteer agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue.