Ice Cream at the Patch Volunteer

Volunteer at Ice Cream at the Patch!

Event: Ice Cream at the Patch
When: Saturday, September 19th at 10:15 a.m.–1:45 p.m.
Where: Jericho Farmhouse
Address: 137 Old Jericho Rd, Smithfield, KY 40068

We’re hosting a fun fall event at Jericho Farmhouse for special needs families, and we need your help!

We need families (yes, bring your kiddos!) to help with registration, hopsitality and helping families as needed, set up/tear down, and engaging with guest parents, caregivers, and children. Guests and volunteers will receive a free pumpkin and ice cream. Volunteers are encouraged to hang around afterward to participate in all the festivities. It’s gonna be a whole lotta fall fun on the farm! Please complete the form below to help us with this fall fun event. 🍂

Ice Cream at the Patch Volunteer Registration

Primary Contact Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Email*
Phone Number*
Format: (xxx) xxx-xxxx
Mailing List Consent
- I want to receive emails about future retreats, community events, and Barren Heights updates!
What types of information are you and your family interested in?*
Number of Family Members Volunteering*
Names & Birthdays of Volunteers (e.g. Alex (7/5/10), Shannon (2/2/11), Blake (6/12/19), Jordan (1/27/22)*
Any food restrictions? (Ex. Dairy, peanuts)
Hold Harmless Agreement

By checking the boxes below and submitting this registration form, you are agreeing to an electronic signature which will act as the legal equivalent of your (the applicant's) manual/handwritten signature on this Hold Harmless Agreement.
Please check if you agree with the following statements:
- I give my consent that the information given at registration may be communicated with leaders and volunteers for the purpose of being equipped to provide the best care and assistance possible to my family.
- I give my consent that photographs, interviews and audio/visual recordings during the course of the event may be used by Barren Heights for training, promotion, and fundraising.
- I release Barren Heights, their directors, and volunteers from all actions, damages, or personal injuries which may occur to me or a member of my family. I understand that in the event of a minor injury, I, or a member of my family may receive first aid treatment. I will be informed as soon as possible of any injury or condition of one of my family members and will be responsible thereafter for their care. In the event of an emergency, injury, or illness, emergency medical services and I will decide the best course of action. If the leaders are unable to reach me, I authorize them to take whatever action is necessary for the safety and health of my family members.
- I understand that in order for everyone to experience a sense of calm, peaceful relaxation, this event is an alcohol, drug, and smoke-free environment. Use of cell phones is discouraged except when necessary.
- By checking this and the above statements and submitting this registration form, I hereby agree to this hold harmless form and all its contents. I waive on behalf of myself, my heirs, and any personal representatives all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss. I understand that this release discharges Barren Heights from any liability or claim that I, my heirs, or any personal representatives may have against them with respect to any bodily injury, illness, death, negligence, medical treatment, or property damage that may arise from, or in connection to any services rendered. This liability waiver and release extends to Barren Heights together with all owners, partners, volunteers, and employees.
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Volunteer at Ice Cream at the Patch!

Ice Cream at the Patch Volunteer Registration

Hold Harmless Agreement

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