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2. Name (First & Last) *
4. Address*

   Please enter your full address, including the zip code.

6. Neighborhood/Plan Name*
8. Email Address*
9. Telephone Number*
11. Are you 60 years of age or older?*

    1. Yes
    2. No
12. If no, do you have any disabilities?

    Please disclose only what you are comfortable sharing.

14. I would like a volunteer to help with shoveling my driveway?*

    1. Yes
    2. No
15. I would like a volunteer to help with shoveling my sidewalk, walkway up to my front door/primary entrance to my residence?*

    1. Yes
    2. No
17. Do you have salt available for the volunteer to use?*

    1. Yes
    2. No

    *Snow Angel volunteers are only required to shovel. 

    However, if you do have salt available, you may request that your angel salts your walkway and/or driveway. Please communicate directly with your angel regarding this.

19. Are you filling this form out on someone else's behalf?*

    1. Yes
    2. No
20. If yes, please describe your relationship to the individual you're requesting an angel for and enter your name and contact information.
24. Please read the following statements in full.
26. Acknowledgment #1*

    I understand that this is a VOLUNTEER program. Volunteers are limited. There is no guarantee that I will be matched with a volunteer. Volunteers are matched by proximity, NOT first come, first serve.

    1. Yes
28. Acknowledgement #2*

    I understand that this IS NOT an on-call service, but rather a volunteer program, and volunteers may or may not be able to assist with snow removal during every snow event. It is my responsibility to find a different service when my volunteer is unavailable. 

    1. Yes
30. Acknowledgement #3*

    1. Yes

    I understand that these volunteers are residents within my community and I agree to treat my volunteer with respect at all times - including if/when they are unable to clear my snow by a certain time or at all during a given snow event, and I understand that maintaining positive and respectful interactions with my volunteer is essential to the program. I further agree that inappropriate behavior of any kind may result in my removal from the program.

32. Acknowledgment #4*

    1. Yes

    I understand that if I am signing up for someone other than myself, I can/will act as the point of contact for that person and communicate between the volunteer and requestee.

34. Terms & Conditions*

    In consideration of my participation in the Township of Hampton Snow Angels Program (the “Program”), I, on behalf of myself and any of my personal representatives, heirs, and next of kin, hereby COVENANT NOT TO SUE and to HOLD HARMLESS, RELEASE, AND INDEMNIFY the Township of Hampton, its officers, agents and/or employees (hereinafter referred to as the “Releasees”) from any and all liability, claims, demands, actions and causes of action whatsoever, brought by any party against any party, arising out of my participation in the Program and whether caused by the negligence of the Releasees or otherwise. This RELEASE, WAIVER OF LIABILITY and INDEMNIFICATION AGREEMENT shall remain valid in perpetuity and shall include all possible claims of negligence or other causes of action that could be asserted against the Releasees by me.  

    1. Yes
36. Photography Agreement*

    As a participant, you give permission to be photographed during/after snow shoveling up in the Snow Angel Program.  You are aware and give permission for photographs or video to be used by the Township of Hampton for publications both print and electronic - i.e., social media, videos, newspaper articles, marketing materials, brochures, rack cards, signage, promotional materials - as well as any other use deemed appropriate by the Township.  You also give permission for a Township representative to be on your property to take photographs for the use of promotion. 

    1. Yes
    2. No
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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field