What's your email address?

Your information


Required fields are marked with an asterisk (*). 5 fields below (1 required) are a file upload/attachment, the size of all uploaded files must be less than 10MB.
Mobile Phone *

For example, 123-456-7890
SMS/text messaging: By providing your mobile number and checking the box below, United Cajun Navy will be allowed to send you SMS (text) messages relating to their volunteer activities. To opt-out, reply STOP to any SMS message OR return to this form and uncheck the box.
First Name *
Middle Name
Last Name *
Street Address *
City *
State *
Zip Code *
Date of Birth *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
*Upload your Driver's License: JPEG or PNG Format Only - A photo NOT your DL can disqualify you.

The total size of any/all file uploads must be less than 10MB
Have you ever been convicted of a felony? *
Select The Categories You Would Like To Volunteer









Zello Handle/ID
Military Experience *

Type any Certifications / Skills or Trades Applicable To Disaster Volunteering
Add'l Information You Would Like To Include
What Are Approximate Dates You Are Available To Volunteer? VERY IMPORTANT! Approximate is fine. Give details as that better helps us with keeping our key leads informed.
Select All You Own or Have Access to. In The Text Box Under Your Selections, Give Details On Each Selected item. ie - size and abilities of Drone, Side Sonar or Bottom Sonar, Size of Boat and Engine, Type of Truck, Size of Trailer etc







VERY IMPORTANT! List Details On Above Assets You Selected - WE NEED DETAILS!!!
PHOTOS OF SAR ASSETS ARE NEEDED - 4 FIELDS ARE AVAILABLE FOR PHOTO UPLOADS. Only 1 photo per field. Uploading additional photos in the same field will overwrite the original upload previously done in that same field.
UPLOAD PHOTOS OF THE FOLLOWING ASSETS IF SELECTED ABOVE.

Assets: Truck, Trailer, Any Vehicle That Can Transport Large Quantities of Supplies, Boat, Drone, Plane, Helicopter
Photo upload- jpeg or png only! This field is for 1 photo upload

The total size of any/all file uploads must be less than 10MB
Upload Photo: jpeg or png only! This field is for 1 photo only.

The total size of any/all file uploads must be less than 10MB
Photo upload- jpeg or png only! This Field is for 1 photo only!

The total size of any/all file uploads must be less than 10MB
Photo upload- jpeg or png only! This field is for 1 photo upload

The total size of any/all file uploads must be less than 10MB
VOLUNTEER WAIVER AND RELEASE OF LIABILITY
In consideration of the risk of injury while participating in United Cajun Navy (the "Activity"), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge United Cajun Navy, located at 2053 W Magna Carta Pl, Baton Rouge, Louisiana 70815, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity.

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH TRAVELING TO AND FROM AS WELL AS PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR THE CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN OR UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY, INCLUDING TRAVEL TO, FROM AND DURING THIS ACTIVITY.

I agree to indemnify and hold harmless United Cajun Navy against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If United Cajun Navy incurs any of these types of expenses, I agree to reimburse United Cajun Navy.

I acknowledge that United Cajun Navy and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of United Cajun Navy.

I acknowledge that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants, equipment, vehicular traffic and actions of others, including but not limited to, participants, volunteers, spectators, coaches, event officials and event monitors, and/or producers of the event.

I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE United Cajun Navy AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST United Cajun Navy FOR PERSONAL INJURY OR PROPERTY DAMAGE.

To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of United Cajun Navy, its agents, and employees.

In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.

In the event that any damage to equipment or facilities occurs as a result of my or my family's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness.

This Agreement was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both the Participant, __________________________, and United Cajun Navy agree that this Agreement is clear and unambiguous as to its terms, and that no other evidence will be used or admitted to alter or explain the terms of this Agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into. I understand that this information may be vetted by a 3rd party to ensure accuracy.

In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause severed does not affect the intent of the parties. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.

I understand that my role is as a volunteer and, as such, I will receive no financial reimbursement for services rendered. I do not have an employment relationship with UCN and I do not expect to receive an offer of employment, entitlement, benefits or compensation for my work as a volunteer. I acknowledge that my service and work provided to UCN is of my own free-will and volition; and that I may be asked to cease my activities without notice. I understand that UCN does not assume any responsibility or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance of any nature in the event of injury, illness, death, or property damage. I expressly waive any such claim for compensation or liability on the part of UCN beyond what may be offered freely by UCN in the event of such injury or medical expenses incurred by me.

I understand that the provision of services, goods and resources to those economically or traditionally disadvantaged largely depends upon the public's trust. Any direct or indirect disclosure of confidential information to anyone outside of UCN would threaten the mission and operations of the United Cajun Navy, cause the public to lose trust in UCN, and would do damage, monetary or otherwise, to the mission and operations of UCN. My association with UCN has or will expose me to confidential information. I expressly acknowledge the status of the confidential information and that the confidential information constitutes a protectable interest of UCN. I will not copy, transcribe, record, or memorize conversations with United Cajun Navy staff or volunteers in any manner, nor disclose or use such information for any purpose without written consent from a United Cajun Navy board member. Confidential information shall mean, but is not limited to, plans, processes, reports, financials, business or strategic plans, compensation, donor lists and donors, client lists and clients (including, but not limited to, clients or donors of United Cajun Navy who I may call or with whom I may become acquainted with while providing the assigned services at UCN) and any information relating or belonging to United Cajun Navy's clients, donors, customers, and any other third-party individuals UCN transacts with whether furnished before or after the date hereof, oral or written, and regardless of the form of communication or the manner in which it is furnished.

I hereby release and agree to hold harmless UCN, its members, affiliates, staff, agents, and volunteers of any and all liability that could possibly be incurred as a result of my negligence, intentional or unintentional, during the commission of my responsibilities as a volunteer for UCN. I release and hold harmless UCN, its members, affiliates, staff, agents, and volunteers of all liability with regard to any physical harm, emotional harm, or property damage that I may sustain during the time I volunteer at United Cajun Navy, or as a result of my participation in any project of UCN as a volunteer, or in any other activity sanctioned by UCN. I release and forever discharge UCN from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical service rendered in connection with an emergency during my tenure as a volunteer.

Responsibility. It is my personal responsibility to conduct myself within the confines of all applicable federal, state, and local laws during my tenure as a volunteer with UCN. It is my responsibility to be familiar with and to adhere to all relevant UCN policies, procedures, instructions and other relevant documentation including, but not limited to any volunteer handbook. It is my responsibility to immediately notify a designated agent of UCN (such as a staff member or volunteer supervisor) if I am witness to or a participant in any activity during my tenure as a UCN volunteer that may jeopardize the safety and well-being of myself and/or others, as well as the successful operation of UCN, including, but not limited to any illegal or illicit activities, unsafe work procedures and conditions, etc. I will bring to the attention of UCN staff any information or questions that arise of a legal nature. While volunteering at United Cajun Navy ,I agree to abide by a code of conduct that will prevent the use of Drugs, Language and actions that do not reflect our core values.
I confirm that I have read and have accepted the United Cajun Navy's Volunteer Waiver and Liability Policy *
Please list an emergency contact name: *
Address
Emergency Contact Email *
Emergency Contact Phone *