Salina Food Program Volunteers

Thank you for your interest in volunteering with the Salina Family YMCA's Grab N' Go Summer Food Program! Volunteers like you make this it possible for this program to serve children ages 3 through 18 who need nutritious food at no cost to their family.

Full name. *

First NameLast Name

Email*

example@example.com

Phone number*

Are you 10 years of age or older?*

YesNo

If no, what is the name of the adult who is accompanying you?*

First NameLast Name

Select the days/times you would like to volunteer:

	2:00pm-4:00pm	3:20pm-6:00pm
May 19
May 26
June 2
June 9
June 16
June 23
June 30
July 7
July 14
July 21
July 28
August 4

Volunteers will need to have a background check for the safety of our young volunteers and childcare facility near our location. Bring a photo ID to the YMCA before volunteering or bring it with you to the volunteer site to complete the process. Please mark below:*

I am 18 or olderI am under the age of 18

Date of Birth

Date

My photo may be used by Salina Family YMCA in marketing materials, editorial, and online web presences, including but not limited to website, social networks, blog, etc.*

YesNo

Do you agree to the liability waiver below?*

Yes

I am an adult of 18 years of age and wish to participate in Salina Family YMCA (the “YMCA”) membership/program and special activities. I agree that my children or legal wards can participate and give them permission to participate in YMCA activities. As used in the Agreement “children” shall include legal wards and “parent” shall include legal guardian. As a condition to being permitted to utilize the facilities, services and programs of the YMCA for any purpose, including but not limited to observation or use of the facilities or equipment, or participation in any off-site program affiliated with the YMCA, I, the undersigned, acknowledge, agree, and represent that I have inspected and carefully considered the facilities and programs. I understand that even when every reasonable precaution is taken, accident can happen. As a condition to participate by me or my children in YMCA activities, on my behalf, and on the behalf of my children, I waive and release any claims for loss or injury incurred or suffered which I or my children might make against the YMCA, its sponsors, officers, employees, volunteers, or contractors as a result of participating in YMCA activities or using its facilities. I further agree to indemnify the YMCA against and hold it harmless from loss incurred as a result of claims against it based upon alleged or omissions by me or my children. I have read this authorization, waiver and release, understand it, and am voluntarily signing it.

Signature