Highlands Ranch Volunteer Registration

Douglas County Household Chemical Roundup
Shea Stadium ● 3270 Redstone Park Circle
Highlands Ranch, CO 80129
Aug 12, 2017

Thank you for volunteering for the 2017 Household Chemical Roundup! Please complete this form and RETURN BY July 28, 2017 so that we may accommodate you to the best of our ability. If you have any questions or are unable to attend after you have registered, please call (720) 200-1580. You’ll be hearing from us soon with more information about the event.






















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*We will try to accommodate your request.


*We will try to accommodate your request.


*We will try to accommodate your request.


Do you have any other training or skills that may be useful? (E.g., Spanish- or other language ability, CPR, etc.)


Please list any physical restrictions or limitations you have that may affect your ability to work.








I hereby acknowledge that I am VOLUNTEERING for the Household Chemical Roundup managed by Tri-County Health Department (hereinafter "TCHD"), and will serve in a VOLUNTARY capacity. I understand that the term VOLUNTARY means actions or services I render at the Household Chemical Roundup will be given free of charge. I further acknowledge that I have not been appointed to any position with TCHD, either express or implied, nor have I entered into a "contract of hire": with TCHD, either express or implied. Furthermore, I understand that because my relationship with TCHD, or any other entity participating in the Household Chemical Roundup, is not that of an employee-employer relationship, that therefore I am not entitled to workers' compensation benefits, or any other benefit, in my capacity as a VOLUNTEER. I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND THE “HOUSEHOLD CHEMICAL ROUNDUP SAFETY PROCEDURES” AND TERMS AND CONDITIONS OF THIS VOLUNTEER ACKNOWLEDGEMENT. I CERTIFY THAT ALL OF THE ABOVE INFORMATION IS CORRECT.


call (720) 200-1580 or vrichard@tchd.org






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