WBTCSP Waiver of Responsibility Form | Wytheville Community College

Volunteer Service Waiver of Responsibility Form

For Students Participating in Wythe-Bland Foundation Scholarship, Twin County Community Foundation Scholarship, or the Smyth County Promise Scholarship Programs

Through

Wytheville Community College

You must submit a Waiver of Responsibility form after you set up volunteer service with the agency but BEFORE you start volunteering. This ensures that you are volunteering with an approved volunteer agency and notifies the Scholarship Program Manager where you will be volunteering.

You are responsible for keeping track of your volunteer hours! Once you complete the required hours for the semester, you will then submit one (1) Student Timesheet so your hours can be verified.

Please select which Scholarship Program you are participating in.

Student's ID #:

First

Last

Suffix

Student's Email

Student's Phone Number

Wythe-Bland Foundation Scholarship and Twin County Community Foundation Scholarship

May only volunteer in the public-school system if they are an education major.

Smyth County Promise Scholarship

May volunteer in the public school system but will need to contact the Smyth County Public School Board Office to determine their needs for volunteering within the public-school system. You will NOT be allowed to volunteer at high school sporting events, unless special permission is given.

All 3 scholarship programs

You cannot volunteer with the church unless they have a non-profit status.

You must receive special permission to volunteer somewhere not listed on the "Approved Agencies" list.

You are responsible for contacting the volunteer agency, setting up hours, tracking hours, and completing the required hours for the semester.

You will submit a Student Timesheet once you have completed your volunteer hours for the semester for the Scholarship Program Manager to verify.

Name of Volunteer Agency

First

Last

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Agency's Contact Person's Email

Agency's Contact Phone Number

I, the undersigned, am entering this activity voluntarily and freely, fully aware of the potential dangers inherent in participating in this volunteer service. I will assume the risk of personal injury in undertaking this activity. I DO HEREBY RELEASE Wytheville Community College, its servants, agents, and employees, the WCC Educational Foundation, Inc. the WCC Scholarship Foundation, Inc., the scholarship program I am under (Wythe-Bland Foundation Scholarship, Twin County Community Foundation Scholarship, or Smyth County Promise Scholarship), its servants, agents, and employees, from any and all liability to me which may result from my participation in the volunteer program.

I agree to these terms

I do not agree to these terms

Student's Signature

Sign above

Date

Parent or Guardian's First and Last Name (if student is under 18 years of age)