Adult Waiver Hearts & Hammers Adult Waiver Name* First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Emergency Contact Person* First Last Emergency Contact Phone*Volunteer Team*None3MAdvent UMCAdvent Lutheran AnokaAECOMASHRAEAssociated BRC/ Associated BankASPEAuto-Owners InsuranceAzroBig-D ConstructionBerg DrywallBKV GroupBauhaus Brew LabsBurns & McDonnellBWBRCarpenter Evert and AssociatesCE ContractingCatholic Heart Work CampC.G. Hill and SonsCHSCity of MinneapolisColliers InternationalCommunity of Minnetonka BeachCreative HomesCuningham GroupDark Clouds Silver LiningDavis & AssociatesDo Good RosevilleDJ KranzDunhamDunwoodyECMCEhlersEgan CompanyFaithful & GouldFederal Reserve BankFinal Coat PaintingFive Oaks ChurchFrana CompaniesGeneral MillsGerdauGood Sam UMCGracoGray Plant MootyGraybarGreiner ConstructionHarris MechanicalHennepin CountyHGA ArchitectsHoly Cross ELCA KansasHome DepotHorwitz MechanicalHumanaHunt ElectricIREMJe DunnInnovative Building & DesignImmanuel Lutheran ChurchKeller WilliamsKnutson ConstructionKraus-Anderson ConstructionLead222Leadous GroupLifetouchLord of Life ChurchMargolisMcGough ConstructionMERGEMetropolitan EndodonticsMeyer Borgam JohnsonMN Builders ExchangeMMCMNCARMNSEAMortensonMSCANCELNDSU Twin Cities AlumniNotre Dame Alumni ClubO'Keefe WoodOld National BankOlympia TechOpusOptumParsons ElectricPerkins + WillPhillips and TemroPope ArchitectsPremier BanksQuartersawnRachel Contracting, Inc.Reell ManufacturingRJM ConstructionRotary Club of EdinaRouzerRSP ArchitectsSicoraSpirit of HopeStahlSt. Peders ChruchSt. Pius XSt. Stephen Presbyterian ChurchSt. ThereseSt. Thomas Becket ChurchSambatekSchadegg MechanicalSharper ManagementSherwin WilliamsSLCStillwater Sunrise RotaryStinson Leonard StreetSurly Gives a DamnSummit MorgageSynchrony FinancialTarget HRTarget FRSTCF BankTee It up For the TroopsThe Hammer HouseThrivent FinancialThomson ReutersTorch MinistryTroop 90UW StoutVeit USAViking ElectricVince KingWalkerWestminister Presbyterian ChurchWestwood Lutheran ChurchWeek of HopeSelect your Team or choose None.WAIVER OF LIABILITY In consideration of the opportunity afforded me to volunteer my labor, materials, and/or equipment to the Hearts & Hammers - Twin Cities, Inc. (H&H) Project, a project in which the homes of low-income disabled and elderly persons will be repaired by volunteers, and in light of the aims and purposes of the community service provided by H&H, in organizing this project, I hereby waive any right, demands, injuries, damages, claims, actions, or cause of action arising as a result of my participation in the Project from which any liability may or could accrue against H&H, its officers and directors and employees, or against any other person or entity volunteering labor, materials, and/or equipment to the Project, collectively or individually. Without limiting the generality of the foregoing, I agree that this waiver shall include any rights or causes of action resulting from personal injury to me or damage to my property due to any active or passive negligence, or other conduct in connection with my activities for the Project, including but not limited to claims arising out of lead-based paint or other hazardous materials, but this waiver shall not apply to conduct that is fraudulent, intentional, or grossly negligent. This waiver also extends to any illnesses I could contract as a result of my participation, such as COVID-19, or other airborne or surface-borne illnesses. I agree that this release is binding upon my heirs, executors, administrators and assigns. I also recognize that the activities associated with this Project are potentially dangerous and could result in serious personal injury or property damage. Nevertheless, I assume the risk of such injury, whether these risks are known or unknown to me, and I absolve H&H and all affiliated individuals and companies from all responsibility or liability of any description. I also grant H&H unrestricted permission to use, copy, reproduce, alter, display, distribute, publish, and/or exhibit any pictures, video or narrative in which I may be included through any means of communication whatsoever for any lawful purpose whatsoever. I further release and discharge H&H from any and all claims arising out of such use or activity. I am eighteen 18 years of age or older, and I have read theSafety Guidelines .Adult Agreement* I have read and agree to the Terms and Conditions above. Hearts & Hammers - Twin Cities 2603 Fairview Avenue North St Paul MN 55113 651-636-0797 www.heartsandhammers.org