25th Year Days of Caring Individual Registration
Please fill out this form regarding yourself:
Volunteer Name: *
Your answer
Phone number: *
Your answer
Email: *
Your answer
What date would you like to participate? *
Required
Activity level preference? (ie: Light/Heavy): *
Your answer
Location preference? (If you have a town preference/inside/outside) *
Your answer
Job task preference? *
Your answer
Describe any special skill or trade that you possess or factors that we should take into consideration when matching you with a volunteer project: *
Your answer
T-shirt size: *
Your answer
Emergency contact name: *
Your answer
Emergency contact relationship to you: *
Your answer
Emergency contact phone number: *
Your answer
MEDIA RELEASE: I hereby grant permission to the United Way of Addison County to use photographs or video of myself and/or my child(ren) in its official United Way printed publications, PowerPoint presentations or World Wide Web site without further consideration, and I acknowledge the United Way’s right to crop or treat the photograph at its discretion. I also acknowledge that the United Way may choose not to use my photo at this time, but may do so at its own discretion at a later date. *
LIABILITY DISCLAIMER: In accordance with the spirit of volunteerism and service, I, assume full and complete responsibility for any injury or accident that may occur to me during my voluntary participation in the 2019 Days of Caring activities. Therefore, I hereby release, indemnify, and hold harmless the United Way of Addison County, the organizers, the agency or project site at which I volunteer and sponsors and supervisors of all activities from any and all liability in connection with any injury (including any injury caused by negligence), in conjunction with volunteer activity on September 19 and/or 21, 2019. I acknowledge that there are certain foreseeable and unforeseeable risks associated with participating in this event, including, but not limited to, illness, traveling to and from the event, and the effects of the weather, all such risks being understood and appreciated by me. *
Any additional questions/information/comments:
Your answer
Please contact Linnea Oosterman, Days of Caring Coordinator for any questions or help at: linnea@unitedwayaddisoncounty.org or 802-388-7189
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