MAD Volunteer Application Form Go Back

Collecting Personal Information - step 1/5

First Name:

Last Name:

Gender:

Birthdate:

E-mail:

Postal Address:

Phone:

Zip or Postal Code:

City:

State:

Country:

Emergency Contact Name:

Emergency Contact Number:

Mobile:

Service Start Date:

Service End Date:

Do you have a valid passport?

Desired Location:

Area of Interest:

Alternatively:

Collecting Education Information - stage 2/5

Provide your educational background information: Here, you can provide a list of all academic levels. Listing from the most recent academic level and below.

Tell us about your work experience:

Why do you want to volunteer/intern? Tell us about why you want to volunteer/intern with Make A Difference.

What other languages do you know? Do you speak any languages besides English? Please list all of the languages that you speak.

Other Information - stage 3/5

Previous travel to other countries: Please tell us about any previous travel you've had to foreign countries (especially developing nations).

Previous volunteer/internship work: Please tell us about any previous volunteer/internship experience you've had. Include location and duties.

What do you hope to gain from this experience? Briefly state what you would like to learn and experience through our program.

What expectations do you have from our organization?

Medical Information - stage 4/5

Medical conditions: Please tell us if you have any medical conditions we need to know about. processing

Dietary needs: Please tell us if you have any dietary needs.

Allergies: Please tell us if you have any allergies, provide as much information as possible.

History of altitude sickness: Have you experienced altitude sickness in the past? Where and when?

Application Confirmation - stage 5/5

How did you find out about Make a Difference? Please tell us how you found us. Was it through a Web site, friend or brochure? If Web site, please indicate which Web site.

Volunteer/Intern Release and Waiver of Liability

This is a Release and Waiver of Liability (the “Release”) by YOU (the “Volunteer/intern”), and, if applicable, in conjunction with (if applicable) the parent having legal custody or legal guardianship of the volunteer, in favor of Make A Difference, Inc., a nonprofit corporation, their directors, officers, employees, and agents.

The Volunteer/Intern desires to work as a volunteer/intern for Make A Difference (M.A.D.) and engage in the activities related to being a volunteer/intern (the “Activities”). The Volunteer/Intern understands that the Activities may include construction and rehabilitating buildings, gardening, teaching, cooking, working with individuals whom have been infected with diseases, serving food (that may be hot), lifting heavy weight items, working in the M.A.D. office, and working at special events.

The Volunteer/Intern hereby freely, voluntarily, and without duress executes this Release under the terms below:

1. Release and Waiver

Volunteer/intern does hereby release and forever discharge and hold harmless M.A.D. and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from Volunteer’s/intern's Activities with M.A.D.

Volunteer/Intern understands that this Release discharges M.A.D. from any liability or claim that the Volunteer/intern may have against M.A.D. with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Volunteer’s/Intern's Activities with M.A.D., whether caused by the negligence of M.A.D. or its officers, directors, employees, or agents or otherwise.

Volunteer/Intern also understands that M.A.D. does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness.

It is the policy of M.A.D. USA and International that children under the age of 16 are not allowed on a M.A.D. work site while there is construction in progress. Federal regulations prohibit minors between the ages of 14 and 15 from working in general construction. Minors between the ages of 16 and 17 may perform general construction work, but may not engage in certain activities that are considered ultra hazardous. These activities include the use of power tools & motor vehicles, demolition, roofing, and excavation operation

2. Medical Treatment

Volunteer/Intern does hereby release and forever discharge M.A.D. from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Volunteer’s/Intern's Activities with M.A.D., or with the decision by any representative or agent of M.A.D. to exercise the power to consent to medical or dental treatment as such power may be granted and authorized in the Parental Authorization for Treatment of a Minor Child.