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10th Annual Day of Caring
Saturday, September 11, 2010
On-Line Volunteer Application
Applications Due September 8,
2010
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You
MUST Print this Page
to Sign BEFORE You hit the
"Send Mail!" Button at the Bottom of the Page. You
may instead Download the PDF or Word Doc (previous page), Print and Manually Fill in the Form. Mail/Deliver or FAX the Signed Form to the United Way Office at the following: United Way of Pike County
Mail: PO Box 806, Milford PA 18337
Office: 201 West Harford Street, Milford PA 18337
Phone: (888) 306-6963 or (570) 296-9980
Fax: (570) 296-5571
Email: uwpc@ptd.net |
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Please join us as the
United Way of Pike County partners you and other volunteers with local
nonprofit agencies to work for a single day on projects that will help
them in serving Pike County residents in need. You must be 14 years of
age or older to participate.
The day will begin at 7:45 am, with breakfast held at the Delaware
Valley High School, Milford. There you will get your work assignment
and free t-shirt before traveling to the agency work site by bus or on
your own. The work day begins at 9:00 am and ends at 3:00
pm. Project completion requires your commitment for the
entire day. Lunch will be provided at the site.
Work clothes and sturdy shoes are a must.
Please complete, sign and mail volunteer application/release form to:
United Way of Pike County, PO Box 806, Milford, PA 18337. For further
information please call 570-296-9980 or toll free at 888-306-6963 or
email uwpc@ptd.net.
Please return form by September 8, 2009.
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United Way of
Pike Annual Day of Caring - Saturday, September 11, 2010
2010
VOLUNTEER APPLICATION/RELEASE FORM
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Age:
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Youth (14-17 years of age; parent signature
required)*
Adult (Over 18 years of age) |
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Prefix :
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Participant's
First Name
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Middle Name/Initial
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Last Name
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Address Line 1
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Address Line 2
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City
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State
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Zip
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E-Mail
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Home Phone
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Work or Cell Phone
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note any special skills or interests (example: painting, construction,
clerical, landscaping, etc.) so that we can try to match volunteers'
skills with the various tasks. |
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I
Can Help
(check all that apply)
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note any limitations you may have with specific tasks and kinds of work
(example: arthritis, allergies, etc.) so that we can try to match
volunteers' special needs with the various tasks. |
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will try,
if possible, if possible, to honor your preferences and requests for
placement. First,
check the appropriate box below |
I can arrange
my own transportation
I do NOT
have my own transportation |
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Second, if you are carpooling, please list the names of
the people you will be carpooling with: |
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| Third,
if you are a member of a team, club, or organization that will be
working at one site, indicate that group here: |
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Please
read and sign below:
I ______________________________,
hereby release, indemnify, and
hold harmless the United Way of Pike County, the organizers, sponsors
and supervisors of all its activities, from any and all liability in
connection with my participation with Day of Caring 2010, conducted at
various non-profit organizations and their clients, throughout Pike
County, on Saturday, September 11, 2010. In addition, I grant
the
United Way of Pike County and its assigns permission to utilize any
photographs or videos taken of me in the conduct of this event through
all forms of media, including United Way’s website.
Participant Signature:
______________________________________________________
Date: ___________________
We MUST have the signature of a parent or guardian if the participant
is under 18 years of age:
Parent/Guardian
Signature:_________________________________________________
Date: ___________________
Pike United Way has various opportunities for volunteers throughout the
year for office assistance, information & referral website
updating and various special events. If you would be interested in
notification of other United Way volunteer opportunities please provide
your preferred contact method below.
Notify
Me by Phone
Notify Me by Email |
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~ IF
USING THE ON-LINE FORM ~
PRINT
FROM BROWSER BEFORE
"SUBMIT MAIL!"
SIGN
AND DATE THE PRINTED FORM
FAX/MAIL/DELIVER
TO UNITED WAY OR BRING SIGNED FORM TO THE REGISTRATION
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UNDER
18 YEARS OLD
MUST
ALSO HAVE PARENT SIGNATURE
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User
agrees with all information on this page and will also provide a signed
printed copy. Print this page then use the "Send Mail!" button below to
email form to the Pike United Way.
User Agrees
(check) |
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Click Here to Print Page and FAX/Mail/Deliver to UWPC |
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