Ready, Set... WALK!!! and Keep Moving Volunteer Form
Sunday, September 23, 2018
Calf Pasture Beach, Norwalk, CT
Contact Betty Cordellos (203) 851-1018 or bcordellos@norwalkchc.org


Volunteer on our READY SET WALK/KEEP MOVING Committee or Volunteer for the Day

Complete the form below to let us know how where you would like to help. Please note, we will do our best to accommodate your preferred job, but to make the Walk a success, we need to fully staff all positions. We appreciate your understanding and flexibility.

We will confirm receipt of your form by email. After your application has been reviewed, we will contact you about your application.


Name *
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Email *
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Phone Number *
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I would like to volunteer on the READY SET WALK planning committee. I am interested in (check all volunteer opportunities that apply): *
Required
Why would you like to join the planning committee? *
Your answer
I would like to volunteer on Sunday, September 23rd, the day of Ready, Set... WALK!!! to prevent childhood obesity and KEEP MOVING. I am interested in the following volunteer opportunities. (Please check all that apply.) *
Required
Please describe your previous volunteer experience with other events/organizations and professional skills you wish to use as a READY SET WALK/KEEP MOVING volunteer.
Your answer
Norwalk Community Health Center 3K Family Walk Release-Volunteers
In consideration of my willingness to volunteer in Norwalk Community Health Center’s 3K Walk, I hereby agree to assume all risks associated with my participation in the event, including but not limited to bodily injuries. I, as well as my estate and heirs, hereby release and agree to hold Norwalk Community Health Center, Inc., including its affiliates, officers, agents and employees, and the event’s participants, sponsors, organizers and volunteers harmless from all claims and legal actions, whether for property damage, bodily injury, or otherwise, arising from my participation in the event.I hereby certify that I am physically able to participate in this event. I consent to emergency medical care and transportation in the event of injury to me as medical professionals may deem appropriate. This Release extends to any liability arising out of or in any way connected with medical treatment and transportation provided in the event of an emergency.I agree to observe and obey all rules and safety procedures that accompany Norwalk Community Health Center’s 3K Family Walk, including any and all instructions from Norwalk Community Health Center staff and event officials. Norwalk Community Health Center staff and event officials may dismiss me should my behavior endanger the safety of or negatively affect an event, person, facility, or property of any kind.I hereby authorize and consent to the use and disclosure of my likeness and the information I provide to Norwalk Community Health Center, Inc., its agents or employees: (i) to the media, including, but not limited to, newspapers, television, and Internet outlets (e.g., Facebook, Instagram); and/or (ii) for the making of photographs, brochures, videos and/or audio of or including my likeness or information by Norwalk Community Health Center, Inc., or its agents or employees, or a third party.I have carefully read this Release and I have had the opportunity to ask questions about it. I fully understand its contents and knowingly and voluntarily agree to the terms and conditions set forth herein, including the assumption of the risk associated with the event and my responsibility as a participant.
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