Emergency Assistance
Non-Emergency Assistance
Completed Projects

Offer to provide a service for an emergency Lions project/mission.

If you have a service you would like to provide, please complete the form below. Your offer will be entered into the Lions Clubs International database. Please read carefully the "Waiver of Liability" at the end of the form.
*Required
*My First Name:  
*My Last Name:  
My Phone Number:  
(Phone numbers will not appear on the Lions Web site. This is a secure site.
Only Lions Headquarters staff will receive phone numbers.)
*My E-mail:  
My Lions club:  
My District Number:  
*My Language Preference:  
My Second Language:  

*I am willing to offer my assistance as a:

Health care professional such as a doctor, nurse, paramedic, etc.
Allied health professional
Social worker
Law enforcement officer
Firefighter
Professional relief aid worker
Scientist such as a geologist
Architect
Carpenter
Construction worker
Electrician
Laborer
Communications specialist
Other  

Waiver of Liability & Indemnity Agreement

The undersigned Project Sponsor agrees and understands that participation in the Lions Emergency/Non-Emergency Assistance Database Program is voluntary. As such, the Project Sponsor his/her heir, personal representatives or assigns, hereby release, waive, discharge and covenant not to sue the International Association of Lions Clubs and Lions Clubs International Foundation, their officers, trustees, employees and agents from liability from any claims including the negligence of the International Association of Lions Clubs, its chartered Lions Clubs, Lions Clubs International, their officers, members, employees and agents, resulting in personal injury, accidents, or illnesses (including death) and property loss arising from, but not limited to, participating in the Lions Emergency/Non-Emergency Assistance Database Program.

The undersigned project sponsor also agrees to INDEMNIFY and HOLD the International Association of Lions Clubs and Lions Clubs International Foundation HARMLESS from any and all claims, action, lawsuits, procedures, costs, expenses, damages and liabilities, including attorney's fees brought as a result of Project Sponsor's involvement in the Lions Emergency/Non-Emergency Assistance Database Program.