Name *

First Name

Last Name

I agree to follow Center of Disease Control (CDC) and local health district guidelines *

I am wishing to volunteer my time and services for Reflective Media Productions hereby acknowledge that said organization is doing everything they can to protect the public as well myself as a volunteer. To this extent, I agree to follow Center of Disease Control (CDC) and local health district guidelines and Reflective Media Productions policies and procedures for social distancing to reduce the spread of Novel Coronavirus, or COVID-19. This will require me to maintain six (6) feet of distance between myself, fellow volunteers, and patrons of the organization as much as possible. This procedure will be required for visitor-to-visitor contact as well to limit exposure.

I agree

I agree to utilize protective masks *

I agree to utilize surgical masks or improvised masks such as scarves, bandanas, and handkerchiefs to reduce the risk of exposure to myself and others. I agree to wash or sanitize my hands after using the restroom, sneezing, and coughing, and before eating or preparing meals or sundries for distribution, and will properly wear and utilize sterile gloves.

I agree

I understand that there is no direct medical health coverage afforded to me by RMP *

I understand that there is no direct medical health coverage afforded to me during my relationship with Reflective Media Productions. Reflective Media Productions is not responsible for any potential exposure to Novel Coronavirus, or COVID-19, which is not a direct result of negligence on the part of their contractors, volunteers, or the organization. I understand that there is no Texas State Labor and Industries employment security insurance provided to me.

I understand

Phone *

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Today's Date *

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