Name *

First Name

Last Name

Emergency Contact (in Houston) *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

By agreeing below, you personally assume all risks and release Houston Improvement Project (HIP) and any other organization or individual involved in this program from any responsibility, obligation or liability for any loss, damage or injury to any person or property that arises in connection with participation in this program. I am at least 18 years of age, or I am a parent or guardian signing up a minor in my household that is 16 years of age of older that has my written consent to attend at Houston Improvement Project Work Day. *

I Agree