Secret Santa Agency Enrollment Form – 2022

Secret Santa 2022- Agency Enrollment

Thank you for your interest in the 2022 Secret Santa program. We are excited that you have chosen to participate this year.

We assure you we are here to help you meet the need of those you serve in our community. Although we are open to serve all, this year we will prioritize children, seniors, veterans and the disabled.

As always, your health and safety, as well as that of our staff and volunteers, is our top priority. We will keep you updated if we need to make any adjustments to the program in the interest of public health safety.

Agency and Program Name

Agency ID

Agency’s Main Phone Number

Agency’s Mailing Address

Executive Director

Phone Number

E-Mail Address

Secret Santa Coordinator/Contact Information

Name of Primary Contact

Cell

Name of alternate contact

Cell

Participation payment of $150 must be made prior to agency training.

Payment Options

Visa/ MasterCard Check will be Mailed

For credit card payments, please finalize the transaction by entering your card details on the following page. Checks payable to CVNL can be mailed to:

Attn: Secret Santa, 153 Stony Circle, Suite 100, Santa Rosa, CA 95401.

Please answer the following questions to help us serve you better this holiday season.

Did you participate in Secret Santa 2021?

Yes Now

1. Do you unwrap your gifts?

Yes No

If yes, do you leave unwrapped?

Yes No

2. How many gift do you plan on requesting this year?

by checking this box and participating in Secret Santa, our agency agrees to the following:

1. Gifts will go to the intended recipients of the program, and cannot be traded, sold or auctioned in any way that is not the purpose of Secret Santa.

2. Agencies will not seek financial benefit from participating in Secret Santa.

3. Agencies will respect the partnerships of Secret Santa with community entities to ensure the success of the Secret Santa program.

4. Individuals participating in Secret Santa shall refrain from any real or perceived conflicts of interest.

5. Agencies will pick up gifts in a timely manner.

6. I acknowledge the contagious nature of COVID-19 and that Secret Santa has put preventative measures in place to reduce exposure. For my safety and that of others, I will comply with CVNL and Secret Santa’s policies, safety rules, and other directions for all activities.

7. I understand that CVNL and Secret Santa activities have inherent risks that may arise from the activities themselves, my own actions or inactions, or the actions or inactions of CVNL and its directors, officers, employees and agents, volunteers, and others present at program sites. I assume full responsibility for any and all risks of bodily injury, death, or property damage caused by or arising directly or indirectly from my presence at program sites or participation in CVNL and Secret Santa activities, regardless of the cause.

8. In consideration for my participation in CVNL and Secret Santa programs, I waive and release any and all claims against: CVNL and its directors, officers, agents, employees, volunteers and affiliates, and the owner(s) of premises on which CVNL and Secret Santa programs take place (collectively, the “Released Parties”), for any liability, loss, damages, claims, expenses and attorneys’ fees resulting from death, or injury to my person or property, caused by or arising directly or indirectly from my presence at a program site or participation in CVNL and Secret Santa activities, regardless of the cause and even if caused by negligence, whether passive or active. I agree not to sue any of the Released Parties on the basis of these waived and released claims.