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2014 Make A Difference Day Volunteer Registration - TEMPLATE

Please correct the field(s) marked in red below:

1

Name:

 *
Name:
2

Please indicate the name of the volunteer organization (e.g., church, school, business, etc.) of which you are part.  Type "NA" if you are not part of an organization.

 *
3

I want to volunteer for any one of the following projects:

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I want to volunteer for any one of the following projects:

Note:  You will be assigned to one of the projects you selected above.  More projects may be identifiedand added to the list.

4

Contact Information:

 *
Contact Information:
5

Emergency Contact Information:

Emergency Contact Information:
6

I am willing to be a team leader, if one is needed.

I am willing to be a team leader, if one is needed.
7

Volunteer Waiver

I accept and agree to the terms stated below and register to volunteer with the City of Goodyear.

 *
Volunteer Waiver I accept and agree to the terms stated below and register to volunteer with the City of Goodyear.

I, desiring to volunteer my time and services hereby agree to release, hold harmless and indemnify the City of Goodyear, its officers, agents and assigns, and its members, officers, agents and assigns, from any and all liability or claims of injury or damages of whatsoever nature which may be incurred by me as a result of my voluntary participation in any program sponsored by the City of Goodyear. If a Goodyear employee, I understand that my volunteer activities for the City of Goodyear will not be covered by workers compensation. I further understand that the work involved in the Program may include activities hazardous to the volunteer.

I further represent and certify that I am physically able to do the various activities described above without limitation, and that I have no disabilities which might prevent me from doing the same.

I hereby grant and convey to the City of Goodyear all rights, title, and interest in any and all photographic images and video or audio recordings made by the City of Goodyear during the volunteer’s activities with respect to the Program, including but not limited to, any royalties, proceeds or other benefits derived from such photographs or recordings.

8

I am 18 years of age or older.

 *
I am 18 years of age or older.

Parental/Guardian Consent Form required if under 18. If you're under 18, print, complete and submit the Parental/Guardian Consent Form with your parent's or guardian's signature, otherwise you will not be able to participate in the event.  

Click here to go to the Parental/Guardian Consent Form.

Thank You for Volunteering!

  1. To receive a copy of your submission, please fill out your email address below and submit.