| BY SIGNING THIS FORM, I AGREE TO THE FOLLOWING: |
| The information contained in this form is true and correct to the best of my knowledge. |
| I have received, read, and understand the Time to Change Generations (TTCG) Guidelines and Policies
for volunteers. |
| I have a PA Child Abuse Clearance Certificate and Criminal Background Certificate up to date. |
| I understand that the PA Child Abuse Clearance Certificate and Criminal Background Certificate
are only acceptable for 5 years from the date issued. In the event that one or both Clearances need to be
renewed, I take full responsibility for covering the expense(s) to obtain the new one(s). |
| I understand that it is my responsibility to update this form with changes to my personal information as they
arise. |
| I currently have no known physical or mental condition that could impair my ability for the full participation
provided or expected from me. |
| If any information I have provided is found to be false or misleading, I can no longer volunteer in the
Time to Change Generations (TTCG) program. |
| I release Time to Change Generations (TTCG) and/or coordinators from any liability and liability for any claims
whatsoever arising or may arise during and after my services. |
