School Registration
Please note that due to funding we are no longer able to provide busing. We apologize for any inconvenience this may cause.
School Name: *
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School Address: *
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Contact Person (First & Last Name): *
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Telephone Number: *
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Email Address: *
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Number of Students: *
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Age Range of Students: *
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Number of Adults: *
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Please remind students to bring rakes if they have them. If you are in need of a few please contact United Way to request some.
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Date Your Group Can Rake: *
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Preferred Time(s) (2 hour minimum): *
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Preferred Area to Rake:
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Additional Comments:
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Media Release/Waiver of Liability Form



705 S. 24th Ave., Ste. 400B
Wausau, WI 54401
Phone: 715-298-5719 • Fax: 715-848-2929
Email: kmischo@unitedwaymc.org


MEDIA RELEASE/WAIVER OF LIABILITY
MAKE A DIFFERENCE DAY 2019

I understand that I am participating in Make A Difference Day as a volunteer for elderly/disabled community residents in the Greater Wausau Area through United Way Volunteer Connection. I understand that, as a volunteer, I may be involved in physical activities that have a potential risk of injury. I assume that risk. I agree that I will only perform volunteer activities that I am comfortable doing. I also agree that I will not hold United Way or the residents I am raking for responsible or liable for any damage or injury to my property or me as a result of my participation in Make A Difference Day. I agree to be responsible for my behavior and to indemnify and hold harmless United Way or the residents I am raking for from any damages or liabilities arising out of my activities as a volunteer in connection with Make A Difference Day.
If I am the parent/legal guardian of a child of mine, who is a minor ( under 18 years) and who is participating, I consent to this release on his/her behalf.
I also grant full permission for United Way Volunteer Connection to use photographs or video footage of me in legitimate accounts and promotions of this event or in promotion of the Volunteer Connection program and its website.
I agree to the Media Release/Waiver of Liability form above for Make a Difference Day 2019
If you have any questions contact Volunteer Connection at 715-298-5719. THANK YOU!
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