Justice Ride Application

Name*
First Last
Today's date*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Age*
Date of Birth*
MM slash DD slash YYYY

Name of School
Currently enrolled?*
- Yes
- No
Level*
- High School
- College: Undergraduate
- College: Graduate

Church Affiliation, if any*
Length of time attending*

T-Shirt Size*
- XS
- S
- M
- L
- XL
- XXL
Do you have any allergies? If so, list them here
Are you taking any medications? If so, list them here
Are you engaged in non-perscription drug use?*
Are you engaged in abuse of alcohol?*
Are you engaged in pre-marital sex?*
Are there any special needs you have? (ex. handicap accessibility)*
Are you interested in participating in a Created Equal internship?*
Have you been on a Justice Ride before?*

How did you hear about the Justice Ride?*
Why do you want to be part of the Justice Ride?*
What do you hope to accomplish during the Justice Ride?*
How are you planning to continue defending preborn children after the Justice Ride is over?*

Name of Reference #1*
First Last
Relationship*
Phone*
Name of Reference #2*
First Last
Relationship*
Phone*

Name of Emergency Contact #1*
First Last
Relationship*
Phone*
Email
Name of Emergency Contact #2*
First Last
Relationship*
Phone*
Email

Volunteer Agreement*
I agree to these terms
1. I understand that if I disregard or violate this volunteer agreement, I may be required to discontinue participation with Created Equal at the discretion of Created Equal.

2. I will always treat people with respect, even if they are angry and/or verbally abusive. I will not shout at people.

3. I will never trespass on private property or disrupt any event at which a Created Equal display takes place. I will obey all applicable laws.

4. I will direct media, university officials, or law enforcement officials to the Created Equal Director.

5. If passers-by threaten Created Equal’s property, I will call for law enforcement officers. I will not attempt to physically intervene.

6. If passers-by threaten Created Equal staff, volunteers, and/or myself, I will call for law enforcement officers. If I am unable to remove myself and others from the presence of threatening persons, I understand that I am allowed to take lawful steps to protect others and myself from risk of injury.

7. I will neither carry nor have any weapons (including firearms) with me.

8. I condemn abortion-related violence in all forms.

9. I permit the use by Created Equal of any video or photos taken of me while volunteering with Created Equal for promotion or other non-commercial purpose.
Waiver*
I agree to the waiver
I agree to use my personal medical insurance as the primary medical coverage payment if accident or injury occurs. In the event that the emergency contacts listed below cannot be reached, I hereby authorize the physician or dentist selected by Created Equal to hospitalize, secure treatment, and to order injection, anesthesia, or surgery.

In consideration of my voluntary participation with Created Equal, I hereby waive all claims of action against Created Equal, Inc. and its officers, directors, employees, and agents, all of which are collectively in this waiver and hold harmless provision referred to as “the Organization”, arising out of my voluntary participation with Created Equal and hereby release, hold harmless, and discharge the Organization from all liability in connection therewith.

Knowing, understanding, and fully appreciating all possible risk, I hereby expressly, voluntarily, and willingly assume all risk and dangers associated with my participation in the event. These risks could result in damage to property, personal and/or bodily injury or death.
I have read this waiver and release and understand the terms used in it and their legal significance. This waiver and release is freely and voluntarily given with the understanding that right to legal recourse against the Organization is knowingly given up in return for allowing my participation with Created Equal.

My signature on this document is intended to bind not only myself but also my successors, heirs, representatives, administrators, and assigns.

I HAVE READ THE ABOVE VOLUNTEER AGREEMENT, INCLUDING THE WAIVER AND HOLD HARMLESS PROVISION, AND BY SIGNING IT AGREE TO ABIDE BY ITS TERMS. IT IS MY INTENTION TO EXEMPT AND RELIEVE THE ORGANIZATION FROM LIABILITY FOR PERSONAL, INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.
Signature*

Did you refer a friend to sign up for the Justice Ride?*

Name of person referred*
First Last

Payment*
Price:
Payment*
Price:
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Justice Ride

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