SAMPLE
UNH Cooperative Extension
Short Term Volunteer
You are hereby recognized as a UNH Cooperative Extension volunteer. The purpose of this form is to comply with
RSA 508:17, the New Hampshire volunteer immunity law which provides legal protection for volunteers by limiting
the liability of an enrolled volunteer who is working within the scope of his or her official duties and responsibilities
as outlined by this document and following the guidelines and policies of the program.
Description of Volunteer activity:
4-H Food Booth Worker
To work in the 4-H Food Booth taking orders, preparing and serving food and soft drinks, collecting money and
making change and/or maintaining condition and cleanliness of area.
I understand I am working under the direction of a 4-H volunteer.
DAY
NAME
TIME IN
TIME OUT
NOTE: This chart form can be modified for specific use as long as Name, Time In and Time Out are documented.
June 2009
The University of New Hampshire Cooperative Extension is an equal opportunity educator and employer.
University of New Hampshire, U.S. Department of Agriculture and N.H. counties cooperating.