Memorial Park Conservancy

Your Personal Information

First Name *

Last Name *

Address *

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Preferred Contact Time:

Phone Morning Phone Evening Email

Have you ever been convicted of a felony? Yes No

If yes please explain:

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Spouse Address Same as Above?
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Speak ReadWrite

Mornings (9-12)

Afternoon (12-5)

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Hours per Week

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Hours per Month

Please Mark the Volunteer Opportunities that Interest You

Will you need special accommodations? Yes No

If yes, Please let us know how we can help you

Where did you Hear about Memorial Park Conservancy Volunteer Opportunities?

Volunteer Waiver

I do hereby agree that I will indemnify and hold harmless the Memorial Park Conservancy, Inc. and Houston Parks & Recreation Department, its officers, agents and assigns, and its members, from any and all liability or claims of injury of whatsoever nature which may be incurred by me as a result of my voluntary participation in the project sponsored by the Memorial Park Conservancy, Inc. and City of Houston Parks and Recreation Department, including but not limited to the following activities.

Possible use of clippers, rakes, hoes or shovels will be needed to assist in the clearing process. Bagging litter and/or debris along designated sites and/or collecting piles of trash and litter to be bagged and transporting debris to collection point.

I further represent and certify to the Memorial Park Conservancy, Inc. and Houston Parks and Recreation Department, its officers, agents and assigns that I am physically able to do the various things enumerated above without limitation, and that I have no disabilities which might prevent me from doing the same.

I certify that either I am eighteen (18) years of age or older, or that my parent or court-appointed guardian has full knowledge of my participation in this event and has given me permission to participate, as evidenced by his/her signature below.

Important Instructions:
Print and mail the signed form to:

Memorial Park Conservancy, Inc.
6501 Memorial Drive
Houston, TX 77007

Undersigned has read the above and understands this waiver

Required Signature

X _____________________________________________________________

ADULT / PARENT

DATE

After you click "Submit Application", a window will pop-up instructing you to print the form. This completed form is also electronically submitted.