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8th Annual Day of Caring
Saturday, September 20th, 2008
Volunteer Application
Applications Due August 28, 2008
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You MUST Print this Page to Sign and Fax/Mail/Deliver BEFORE You hit the
"Send Mail!" Button at the Bottom.
You may Instead Download, Print and Send in the Paper Form
Volunteer Sign Up Application
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Please join us as Pike United Way 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 people in need all year long. You must be 14
years or older to participate.
The day will begin with breakfast held at both the Delaware Valley High School and Wallenpaupack High School at
7:45 am [Notice: Breakfast will no longer be at the WAHS].
There you will get your work assignment and free t-shirt before traveling to the agency work site 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 by the agency 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 888-306-6963 or email uwpc@ptd.net.
See you on September 20th! |
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United Way of Pike Annual Day of Caring - Saturday, September 20th, 2008
2008 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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| Please 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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| Please 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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| If possible we will try to honor requests for preference agency, placement for carpooling reasons,
etc: |
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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 in Day of Caring 2008, conducted at various non-profit organizations and their clients, throughout
Pike County, on Saturday, September 20, 2008. 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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| First Click Here to Print Page |
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