Name *

First Name

Last Name

Phone *

(###)

###

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Commitment *

I can commit to volunteering in the same classroom for 2 hours once a month for an entire school year.

Which weekdays are you available?

Select which day(s) of the week and class time(s) works best for your schedule.

Mon 8-10 AM

Mon 10-12 PM

Mon 12-2 PM

Tue 8-10 AM

Tue 10-12 PM

Tue 12-2 PM

Wed 8-10 AM

Wed 10-12 PM

Wed 12-2 PM

Thur 8-10 AM

Thur 10-12 PM

Thur 12-2 PM

Fri 8-10 AM

Fri 10-12 PM

Fri 12-2 PM

Are you interested in weekends?

We also organize small projects on select weekends for those who are busy throughout the week.

Yes

In what city do you prefer to be placed?

Please select one.

Santa Clara

Milpitas

Oakland

Redwood City/Easy Palo Alto

Have you volunteered with us before?

Yes

No, this is my first time volunteering with SiE

Friends/co-workers

I have a group of friends/co-workers that I would like to volunteer with.

Are you fully vaccinated? *

A person is “fully vaccinated” two weeks after completion of the entire recommended series of vaccination (usually one or two doses) with a vaccine authorized to prevent COVID-19 by the federal Food and Drug Administration, including by way of an emergency use authorization.

Yes

No

Decline to state

Face covering *

I agree to wear a face covering at all times as required by mandate

This document sets forth the responsibilities and understandings of the volunteer and of Science is Elementary regarding volunteer's participation in volunteer programs partially or wholly coordinated by Science is Elementary. *

Please check each box to confirm you've read and understand that the materials and tools provided by Science is Elementary are and remain the property of Science is Elementary, and agree to return these tools and any remaining materials to Science is Elementary at the end of my volunteer service.

The volunteer performs the service of the volunteer's own free will, without promise, expectation, or receipt of remuneration. The volunteer is not an employee or agent of Science is Elementary for any purpose and the volunteer's services are not controlled nor mandated by Science is Elementary.

If the volunteer is under the age of 18, the volunteer may only participate in volunteer service with the express written consent of the volunteer's parent or guardian.

The volunteer understands and agrees that it is possible that the volunteer may be injured or otherwise harmed during volunteer service due to accidents, acts of nature, the volunteer's negligent or intentional acts, or the negligent or intentional acts of others; that while Science is Elementary has taken some steps to reduce the chances of injuries or harm to the volunteer, that Science is Elementary has no control over most risks, and, thus, cannot and does not guarantee nor take any responsibility for the safety of the volunteer or the volunteer's property while the volunteer is engaged in volunteer service; and that the volunteer must take full responsibility for himself or herself and assume the risk of harm or damage while serving by taking all necessary and reasonable precautions and acting in a manner that will help protect himself or herself and his or her property.

The volunteer agrees to abide by the directives and guidelines in effect in California, as well as the county, city and school district in which volunteering occurs to disrupt the spread of COVID-19.

The volunteer acknowledges that participation in Science is Elementary programming could result in one contracting COVID-19, respiratory failure, death, and/or the transmission of COVID-19 to family or household members and others who may also suffer these effects.

The volunteer knowingly and voluntarily assumes all risks and dangers, known and unknown, that are associated with any exposure to COVID-19, including, but not limited to, suffering any type of medical condition, illness and, potentially, death.

The volunteer agrees to waive and release Science is Elementary from any and all potential claims for injury, illness including any potential or actual exposure to COVID-19, damage, or death which the volunteer may have against Science is Elementary that might arise out of the volunteer's service and to hold Science is Elementary harmless there from.

The volunteer agrees and understands that injuries or losses to others, such as co-workers or the person(s) being helped, may occur as a result of the volunteer's negligent or intentional acts during volunteer service, and that to avoid such harm, the volunteer must exercise care and act responsibly in serving others.

If any injury or loss to another does occur due to the volunteer's intentional actions or due to volunteer's negligent actions arising outside of the scope of the volunteer's activities, the volunteer must accept the liability for and repair, or make reparations for, the harm done.

Science is Elementary is not providing the volunteer with insurance coverage for any injuries, conditions, or losses to the volunteer arising out of volunteer activities.

The volunteer must maintain his or her own primary medical insurance and the volunteer's own automobile liability insurance when driving a non-Science is Elementary vehicle to cover potential medical and other costs related to the volunteer service; and the volunteer is also encouraged to maintain property and life insurance coverage while serving as a volunteer.

All costs for injury or loss above the coverage provided by the volunteer's insurance are the volunteer's personal responsibility.

Since volunteers are not Science is Elementary employees, Science is Elementary does not provide workers' compensation coverage for injuries or illnesses to the volunteer arising out of volunteer activities.

Parent or guardian

If the volunteer is under 18 years of age, a parent or guardian must read and sign the following. This release, its significance, and assumption of risk have been explained to and are understood by the minor.

First Name

Last Name