ASGHA Volunteer Registration Form
Please fill out completely to become an ASGHA Volunteer for Logan's Run April 21, 2018!
Email address *
Last Name *
Your answer
First Name *
Your answer
Phone Number *
Your answer
Mailing Address *
Your answer
Age (You must be at least 15 years old to volunteer for Logan's Run) *
Your answer
County of Residence *
I would like to be a volunteer for the following (preferences will be taken into account but not guaranteed as Volunteer Position Assigned): *
5K Race Volunteer Checkbox (Check all that apply-preferences will be taken into account but not guaranteed as Volunteer Position Assigned)
Walk Volunteer (Check all that apply-preferences will be taken into account but not guaranteed as Volunteer Position Assigned)
DUAL Volunteer Checkbox (Check all that apply-preferences will be taken into account but not guaranteed as Volunteer Position Assigned) Use OTHER Box to provide specific positions in which you are interested.
Individual(s) I would Like to Work With (Preference will be considered but is not a guarantee of Volunteer assignment)
Your answer
WAIVER/PHOTO RELEASE: In consideration of my desire to participate in the events and related activities sponsored by the Autism Society Greater Harrisburg Area (ASGHA), I agree to assume all risks attendant thereto and, thus, hereby release, hold harmless and forever discharge ASGHA and each and every officer, director, agent, employee, and authorized volunteer from all claims, causes of action, judgments, damages or demands, of any kind from or by myself, heirs, executors, administrators and assigns, for personal injuries and property damage which I may cause or sustain during the event whether known or unknown, foreseen or unforeseen. I agree to indemnify and defend ASGHA for liability arising from any tortuous acts or omissions. I also understand photographs/videos may be taken during the event which may be used on ASGHA's website, listserve or various social media platforms at the discretion of the ASGHA board/staff and agree to release all rights forthwith. I am aware that this is a waiver, release of liability and photo/video release between myself, those registered in my party, and all of the parties named above, and sign it (by hand and/or electronically) on my own free will. I understand that an Adult/Caregiver MUST be on premises at all times. I also understand certain respite room rules are in place for the safety and enjoyment of all participants. Questions or concerns about childcare/teen group will be sent to LogansVolunteers@autismharrisburg.com (PLEASE TYPE INITIALS AS ELECTRONIC SIGNATURE) *
Your answer
I understand that this Volunteer Registration for does NOT register me for the Race/Walk. To register as a participant, please visit: bit.ly/L5K2018asgha (PLEASE TYPE INITIALS AS ELECTRONIC SIGNATURE) *
Your answer
A copy of your responses will be emailed to the address you provided.
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