Volunteer Waiver

Name *
Birthdate *
Phone *
Would you like to receive Iskashitaa Refugee Network emails?
Emergency Contact
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
-List any allergies to medicine, foods, etc. -List any history of serious illness (diabetes, asthma, epilepsy, etc.) or recent injuries or hospitalization -Date of last tetanus shot -What medications are presently being taken?

(If in a group list the name of the group)

Liability Waiver