United Way 2019 Day of Caring Registration
The Day of Caring Volunteer Registration Form: every participating volunteer must fill out prior to receiving a project assignment and prior to participating in the event.

Access Policies and Procedures manual for all volunteers at uwbarthco.org

United Way fights for the health, education, and financial stability of every person in every community. These focus areas have been identified as building blocks essential to forming a better life. Thank you for your interest in making a positive difference in someones life by the lending of your time, talent and skills.

Please answer all of the following:

Name *
Your answer
Email *
Your answer
Address *
Your answer
Phone *
Your answer
Emergency Contact Name and Cell *
Your answer
Volunteer Liability and Photo Release
I, for myself and my heirs, executors, administrators and assigns, hereby release, indemnify and hold harmless United Way of Bartholomew County from all liability for any and all risk of damage or bodily injury or death that may occur to me (including any injury caused by negligence), in connection with any volunteer efforts in which I participate. I likewise hold harmless from liability any person transporting me to or from any activity. As a volunteer associated with United Way of Bartholomew County, I understand that I may have either direct or incidental access to information about individuals, organizations, and/or businesses and that all such information is considered to be private and confidential; it is further agreed that such information will not be disclosed or used for any purpose other than to complete a volunteer duty.

Our policy is to provide equal opportunity to all. We do not discriminate any aspect of employment or service because of race, color, sex, national origin, religion, age, mental or physical disability (including HIV/AIDS), sexual orientation or any other criterion.

I further agree to abide by the Policies and Procedures of United Way of Bartholomew County. I give my consent to the United Way of Bartholomew County to use my name and likeness to promote United Way of Bartholomew County, its fiscal agent, and/or their activities. I give my consent to the United Way of Bartholomew County to store my information in a Volunteer Registration Database. Your personal information will not be used externally or sold.

I acknowledge an understanding of and agreement with the following statements:
- I desire to work as a volunteer and engage in the activities related to being a volunteer.
- I will abide by all safety instructions and information provided to me before and during all activities.
- I understand that in accordance to State law, the use of power tools is prohibited under the age of 18.
- I permit the use of photographs or videos taken of me for publicity or training purposes.
- I have no known physical or mental condition that would impair my capability to participate fully, as intended or expected of me.

Further, I expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the State of Indiana, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I have carefully read the foregoing release and indemnification and understand the contents thereof and sign this release as my own free act. Volunteer's credentials were recorded as presented. Verification of credentials is the responsibility of the receiving agency or ESF.

I have carefully read the afore mentioned Volunteer Liability and Photo Release and understand the contents thereof and sign this release as my own free act. *
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