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Teen/Tween Social & Parent Night Out Volunteer Application

2023 Dates: January 6, February 3, March 3, March 31, May 5
June 2, September 1, October 6, November 3 and December 1

6 p.m. – 9 p.m.

COVID-19 Precautions: All attendees agree to wash hands & temperature check upon arrival. (Sent home if 100°F or above).

Questions? Email Karri Axtell at kaxtell@arcoffortbend.org.

Volunteer Criteria:

Teen volunteer 14+ and adults age 18+
Adults must consent to a criminal background check (good for 2 years)
Volunteers matched 1 to 1 or small group with a Teen/Tween participant

Program Guidelines:

Events are held at The Family Life Center at Christ Church – Sugar Land, 3300 Austin Pkwy, Sugar Land, TX 77479
Volunteer application deadline is 7 days prior to each event
Volunteer hours are 5:45 p.m. to 9 p.m.
DATE REMOVED ONCE REGISTRATION IS FULL

If you have any questions, you may contact Karri Axtell at kaxtell@arcoffortbend.org or 281-494-5924.

Step 1 of 4

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Volunteer Information
2022 Dates:*
- January 6
- February 3
Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Sex*
Date of Birth (MM/DD/YYYY)*
Are you a minor? (Under age 18)*
- Yes
- No
Adult volunteers: Will you consent to a criminal history background check?
- Yes
- No
Students: School You Attend
Adults: Employer & Occupation
Minor Volunteer Information
Parent/Guardian Name*
Relationship*
- Mother
- Father
- Legal Guardian
Parent/Guardian Phone*
Parent/Guardian Email*

Emergency Contact Information
Emergency Contact Name
First Last
Relationship to Contact
Emergency Contact Phone

Background Information - Volunteer Experience
Organization
- Clements High Interact
- National Charity League
- Unite & Inspire
List any volunteer experience (Date - Organization - Position or project)
Do you have prior experience working with individuals with intellectual or developmental disabilities? If so, include here*
Please select which teen you are comfortable being matched up with for the event.
Sex*
- Male
- Female
- OK with either sex
Age Group*
- 11 - 14
- 15 - 18
- OK with either age group
Support Needed*
- Mild Assistance Only
- Moderate Assistance Needed
- OK with Mild or Moderate Assistance

The Arc of Fort Bend County and Texana Center Activities Release and Waiver of Liability
This program is not licensed by the State of Texas. By signing below you agree to accept the terms.

This activities release and waiver of liability is being executed in favor of The Arc of Fort Bend County, The Arc of Texas, The Arc National, Texana Center and/or any affiliated entities, their Directors, Officers, Employees, volunteers and agents (together, “The Arc and Texana”), for the activities described below. I freely and voluntarily execute this activities release and waiver of liability, and agree to the following terms:
GENERAL RELEASE AND WAIVER*
- I/we, the undersigned, understand that by participating in the activity that accidents and exposure to diseases, such as COVID-19, may occur. I/we understand and freely assume all risk involved with participating in the activity and assume the risks which I/we accept may lead to property damage, minor or serious personal injury, illness or even death. By signing this Agreement, I/we intend to legally bind myself, my minor children, wards, heirs, executors and administrators. I/we hereby release and forever discharge and hold harmless the Organizations, 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 at any time from the associated activity.
INDEMNIFICATION*
- I/we, the Undersigned, agree I/we shall indemnify, defend, and hold harmless the Organizations, its Directors, Officers, Employees, Clients, Volunteers, Agents, and its successors and assigns from any and all liability, claims, costs and losses, whether related to property damage, minor or serious personal injury, illness or death and exposure to, injury loss or death related to COVID-19, arising from the Undersigned’s participation in activities, whether caused by the willful or negligent acts of Undersigned or the negligent acts of the Organizations. This provision shall survive the term of this agreement.
VOLUNTEER CONSENT*
- I understand and certify that my participation in the Organizations Teen-Tween Social and Parent Night Out is completely voluntary. I have familiarized myself with the program and activities in which I will be participating. I acknowledge that although safety measures and reasonable care to minimize the risk of injury are taken, the Organizations cannot ensure or guarantee that the volunteers, equipment, premises or activities will be free of hazards, accidents or injuries. I have received approval from a doctor authorizing me to participate in the activities. I understand this program is NOT licensed by the state of Texas.
INSURANCE*
- I understand and certify that my participation in the Organizations Teen-Tween Social and Parent Night Out is completely voluntary. I have familiarized myself with the program and activities in which I will be participating. I acknowledge that although safety measures and reasonable care to minimize the risk of injury are taken, the Organizations cannot ensure or guarantee that the volunteers, equipment, premises or activities will be free of hazards, accidents or injuries. I have received approval from a doctor authorizing me to participate in the activities. I understand this program is NOT licensed by the state of Texas.
MEDICAL TREATMENT*
- If emergency treatment is necessary, I give permission to be taken to the nearest hospital for treatment, by ambulance. I understand treatment is not covered by the Organizations. The undersigned releases and forever discharges the Organizations from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with activities of the Organizations.
COVID-19 RISK:*
- I am aware of and accept the risk related to appearing in-person at an activity conducted by or affiliated with the Organizations. I accept and assume the risk that my in-person participation may cause exposure to, injury or illness from COVID-19, which may lead to health-related injuries, illnesses, including death. I am aware of and accept the risk related to appearing in-person at an activity conducted by or affiliated with the Organizations. I accept and assume the risk that my in-person participation may cause exposure to, injury or illness from COVID-19, which may lead to health-related injuries, illnesses, including death.
VOLUNTEER EXPECTATIONS*
- I agree to conform to the program rules and expectations of all volunteers. I agree to arrive at the assigned time to receive training and instructions regarding the event, my assigned duties, and/or the participant I have been matched with. If I am not performing in accordance with the program rules and expectations, I understand I may be asked to leave, and /or not allowed to return as a volunteer for future activities.
CONFIDENTIALITY*
- The undersigned understands that information regarding the Teen-Tween Respite participants and their personal, financial, disability, health, medical and other related information is confidential. I agree to keep all such information confidential. I understand that unauthorized disclosure of such information is grounds for immediate termination as a volunteer, and may result in additional legal action taken against me
VOLUNTEER BACKGROUND CHECK*
- I consent to The Arc performing a background check to gather information relating to any criminal history and/or sex offender history through SureHire 360.
MEDIA RELEASE*
- The undersigned agrees to the digital, print or other medium use of their likeliness, and waives all rights and interests in such materials.
ACKNOWLEDGMENT*
- By signing below the Undersigned acknowledge that I have read the foregoing release and waiver of liability and understand its contents. I am at least eighteen (18) years old and fully competent to give my consent, or, I have legal authority to consent for each of the undersigned minors/wards. I have been informed of the risks involved and give my voluntary consent as a free act and deed with full intention to be bound by this document. I sign the Agreement free of any inducement or representation. The undersigned expressly agree that the Agreement is intended to be broad and inclusive as permitted by the laws of the State of Texas.
ADDITIONAL TERMS*
- The undersigned expressly agrees that the activities release and waiver of liability are intended to be as broad and inclusive as permitted by the laws of the State of Texas. This agreement shall be governed and interpreted in accordance with the laws of the State of Texas, U..S.A. I agree if any provision of this agreement shall be declared by any court of competent jurisdiction to be illegal, void, or unenforceable, the other provisions shall not be affected but shall remain in full force and effect. This agreement shall be binding on and inure to the benefit of the parties hereto and their respective heirs, legal or personal representatives, successors, and assigns.
Volunteer Name*
Date*
Signature*

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