Ashland Nursing and Rehabilitation Center Volunteer Waiver 2025-2026

Form fields marked with an asterisk (*) are required.

Ashland Nursing and Rehabilitation Center Volunteer Waiver 2025-2026

Please fill out this waiver once an academic year for bingo volunteer events.

Additionally, you must RSVP to each date depending on which ones you choose to attend.

RSVP required October 3: https://thebuzz.rmc.edu/event/11451887
RSVP required November 7: https://thebuzz.rmc.edu/event/11451888
RSVP required December 5: https://thebuzz.rmc.edu/event/11451889
Spring TBA

If you need a ride, please email kendragrimes@rmc.edu 24 hours prior.

First and Last Name:

RMC Email:

Phone Number:

Emergency Contact First and Last Name:

Emergency Contact Relation:

Emergency Contact Phone Number:

Required

I certify that I will attend the service event (you must email esimmons@rmc.edu 24 hours before if you will not be attending).

Required

I am aware that riding in the College van and attending the service event involves inherent risks, including, but not limited to, the risk of injury, property damage, or death.
I voluntarily choose to ride in the College van and attend the service event and hereby assume all risks associated with my participation.
I release, waive, and discharge Randolph-Macon College, its officers, employees, volunteers, and agents from any and all claims, liabilities, demands, actions, or causes of action arising out of or related to any loss, damage, injury, or death that may be sustained by me during van usage, if I choose to drive myself or others, and the service event.
I agree to abide by all rules and regulations set forth by the organizers of the van ride and service event.
I grant permission to Randolph-Macon College to use my likeness in photographs, video recordings, or any other media for promotional or educational purposes.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND VOLUNTARILY SIGN IT OF MY OWN FREE WILL.

Signature (type full name):