Name *
Address *
include both PO Boxes and Physical Address if necessary.
Phone - Home *
Phone - Home
Phone - Mobile
Phone - Mobile
Marital Status *
In Case of Emercency
Name 1 *
Name 1
Primary Phone *
Primary Phone
Phone - Other *
Phone - Other
Address 1 *
Address 1
By writing my first and last name below, I affirm my agreement to the following Release of Liability - as if I was placing my signature below. As a volunteer, I understand and am aware of the risk associated therewith and voluntarily assume such risks as a volunteer that by participating in and with the Nehemiah Projects Team in rendering services to aforementioned project and any further projects I participate with. If accepted as a member of this Nehemiah Project Team, I agree to: Release and discharge the organizations and individuals which helped make these arrangements, including the their agents, employees, officers and volunteers from all claims, demands, actions, judgments or executions that I have ever had, or now have, or may have, or which my heirs, executors, administrators, or assigns may have or claim to have, against these organizations, their agents, employees, officers and volunteers, and their successors or assigns, for all personal injuries, known or unknown and injuries to property, real or personal, caused by, or arising out of this journey. I intend to be legally bound by this statement.