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2. Student Information
   Please provide the following information about the student volunteer.
4. First Name
5. Last Name
7. Grade Level
   -- Select One --8th9th10th11th12th
8. School
12. Parent/Guardian Contact Information
14. Name
15. Email Address
17. Address
19. City
20. State
21. Zip Code
23. Phone Number
24. Secondary Phone Number
26. Emergency Contact
28. Name
29. Email Address
31. Address
33. City
34. State
35. Zip Code
37. Phone Number
38. Secondary Phone Number
42. Persons Authorized to Pick Up the Participant
44. First Name
45. Last Name
46. Phone Number
48. First Name
49. Last Name
50. Phone Number
52. First Name
53. Last Name
54. Phone Number
58. I certify that I am the parent or legal guardian of the minor child listed above. I authorize Williamson County Library personnel to provide emergency medical care for my child participating in the volunteer program. I understand as legal parent or guardian of the minor that Williamson County and the Williamson County Library, their agents and employees, and volunteers are not responsible for any injury to the minor which may result from the minor participating in any volunteer activities. I agree to hold harmless, indemnify and release Williamson County, Williamson County Library, their agents and employees, and any other volunteers from any liability for any injury or damage sustained or associated with the participating in any volunteer activities.
60. Electronic Signature Agreement for Parent/Guardian*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
62. Electronic Signature*
64. Electronic Signature Agreement for Participant*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
66. Electronic Signature
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field