Emergency Contact information

Where did you hear about this volunteer opportunity?

I UNDERSTAND THAT IF I AM INJURED IN THE COURSE OF THE PROJECT, I AM NOT COVERED BY TEAM MIRANDA STRONG’S WORKERS COMPENSATION PROGRAM. I authorize Team Miranda Strong to seek emergency medical treatment on my behalf in case of injury, accident or illness to me arising from my involvement as a volunteer. I understand that I will be responsible for medical costs incurred by such accident, illness or injury. Your typed name below constitutes signature.