United Way of Essex and West Hudson

Personal Information

Name*

First Last

Date of Birth

optional

Email*

Enter Email Confirm Email

Mobile Phone

Home Phone

Work Phone

What is the best way to contact you?

E-mail
Mobile Phone
Home Phone
Work Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Information

Emergency Contact Name

First Last

Relationship

Phone

Additional Information / Availability

What days are you available to volunteer?

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

What time of the day are you available?

Morning
Afternoon
Evening

Are you a student volunteering to fulfill a certain amount of community service hours?

Yes
No

Name of School*

Number of hours needed*

Deadline date to complete required hours*

Interests / Qualifications

Which areas you are interested in volunteering?

Check all that apply.

Advocacy
Clerical/Data Entry
Community Services
Moving / Item Transport
Events
Mailings
Off-Site Opportunities

Skills / Qualifications

Physical / Medical Limitations

TERMS AND CONDITIONS

Volunteer Agreement
In agreeing to this liability waiver, I certify that I am a willing participant in the United Way of Essex & West Hudson (UWEWH) volunteer program. I agree to work according to instructions I receive. I agree to behave in a responsible manner. I agree to perform only work that I feel comfortable in doing and that I feel I can accomplish safely.

Permission – Use of Photographs
I grant permission to use individual and group volunteer photographs, films and videos of me for promotional or other uses furthering the mission of the UWEWH, including use on the UWEWH website.

Acknowledgement and Assumption of Risk
I recognize that the opportunity to participate in the UWEWH volunteer program may involve physical labor and may carry a risk of personal injury and I hereby agree to assume all risks which may be associated with my participation.

I hereby release, discharge, waive and relinquish all claims, liabilities and damages I may sustain from bodily injury, personal injury or property damage and hold harmless the UWEWH, its officers, directors, employees and agents.

CONSENT*

By checking this box, I acknowledge that I have read this form and fully understand that by signing this form I am giving up legal rights and/or remedies which may otherwise be available to me regarding any losses I may sustain as a result of my participation.

I Agree

OUR MISSION