Volunteer Form

Volunteer Form

Volunteer with Sickle Cell Association of Kentuckiana!
Contact Information
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Are you associated with a particular group or organization? If yes, who?
Raise Red, Red Cross, etc.
How did you find out about volunteer opportunities with SCAK?
Friend, Facebook, Humbler, etc.
How are you affected by SCD/SCT?

Other
How are you affected by SCD/SCT?

Other
What type of volunteer position interests you at the moment?

Other
What type of skills do you bring to SCAK?
What types of SCAK activities interest you?
Do you have any medical condition(s) that could affect your volunteer participation?
Conditions we should be aware of in case of an emergency, such as diabetes, high blood pressure, arthritis, thyroid disease, etc.
Emergency Contact
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Volitional Worker Waiver & Release
Abstention
Waiver & Release

I affirm that I am the parent or legal guardian (if the volunteer is a minor) of the participant and am agreeing to the release & waiver of liability on their behalf. I certify that I have the authority to sign on behalf of the participant and to make decisions for the participant regarding volunteering. I also waive and release Sickle Cell Association of Kentuckiana, Inc. Parties from any and all liability, claims, costs, and damages of any kind which I may have resulting or arising directly or indirectly from the participant’s participation in volunteering. I have read this release & waiver of liability and fully understand that by checking this box, I am giving up legal rights and remedies that may be available to the participant, to me, and to other persons.
Waiver & Release

I affirm that I am the parent or legal guardian (if the volunteer is a minor) of the participant and am agreeing to the release & waiver of liability on their behalf. I certify that I have the authority to sign on behalf of the participant and to make decisions for the participant regarding volunteering. I also waive and release Sickle Cell Association of Kentuckiana, Inc. Parties from any and all liability, claims, costs, and damages of any kind which I may have resulting or arising directly or indirectly from the participant’s participation in volunteering. I have read this release & waiver of liability and fully understand that by checking this box, I am giving up legal rights and remedies that may be available to the participant, to me, and to other persons.
Digital Signature

First NameLast Name
Signee relationship to volunteer:
Today's Date

MonthDayYear
Should be Empty:

Volunteer Form

Contact Information

Emergency Contact

Volitional Worker Waiver & Release