Volunteer Registration Form First Name *Last Name *Street Address *City *State/Province *ZIP / Postal code *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint HelenaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. MartinSt. Pierre & MiquelonSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluU.S. Virgin IslandsUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweEmail Address *Phone *Is this participant under 18? *YesNoEmergency Contact *WaiverI understand that in order to maintain an environment that is safe, inclusive and positive for all participants, Fuerza Latina Community Services reserves the right to dismiss a participant for any behaviour deemed as unacceptable. *YesI understand that I/my child/ward should not attempt to take part in any activity with which they are not familiar, without first receiving instructions. I also agree that I /my child/ward must abide by any policies of Fuerza Latina Community Services concerning the use and operation of its facilities. *YesI hereby release Fuerza Latina Community Services and its employees, servants and agents from any and all claims whatsoever, which may be caused by, or arise from my/ my child/ward’s participation in any and all activities and events online and in-person organized or sponsored by Fuerza Latina Community Services; except where the damage or injury is caused by the negligence of Fuerza Latina Community Services or its agents, officers and employees acting within the scope of their duties. *YesI further agree that I, the undersigned, have no knowledge of any physical illness, disability or other reason that could cause my / my child’s/ward’s participation to prove hazardous to my/their health. I understand that by signing this consent waiver, I am allowing myself / my child/ward to actively participate in the activity as outlined above. *YesI further agree that I, the undersigned, have no knowledge of any physical illness, disability or other reason that could cause my / my child’s/ward’s participation to prove hazardous to my/their health. I understand that by signing this consent waiver, I am allowing myself / my child/ward to actively participate in the activity as outlined above. *YesPhoto Release ConsentI understand that by signing this form, I consent that the video, photographs and/or film in which I appear may be used by Fuerza Latina Community Services, its assigns or successors, to promote Fuerza Latina Community Services events and programs. Furthermore, I hereby consent that such photographs, films and recordings made shall be their property, and they shall have the right to sell, duplicate, reproduce, and make other uses as they may desire free and clear of any claim whatever on my part. This photo release will be used for Photographs/videos taken at any event offered by Fuerza Latina Community Services. *YesPROGRAM REFUNDS and CANCELLATIONS Fuerza Latina Community Services ("we") is a small not-for-profit organization that invests significant resources into planning and delivering quality programs for the community. To ensure sustainability and fairness, the following Refund Policy for Programs applies: *All Program fees are non-refundable. *Credits may be offered instead of refunds for cancellations over 14 days for special circumstances and at our sole discretion. *No-show is not eligible for a refund or credit. If a program is cancelled by Fuerza Latina Community Services due to low enrollment, facilitator illness, or other unforeseen circumstances, participants will be offered: *A full refund of program fees, or a credit toward another program of equal value, if preferred *We reserve the right to modify program dates, times, facilitators, or content when necessary. *All requests must be submitted in writing to info@fuerzalatinaservices within the applicable timeframes. I understand all the terms and conditions above by signing this consent.Signature *Please type your name to be counted as an electronic signatureDate *Signature of Participant (over 18 years old)Parental/Legal Guardian Signature 2I consent to receiving emails for Programs and Events from Fuerza Latina *YesNoBy submitting this form, I agree to be bound by the terms of the Volunteer Agreement. My submission serves as my electronic signature and carries the same legal effect as a handwritten signature. Submit