Volunteer Form
Volunteer with Sickle Cell Association of Kentuckiana!
Contact Information
Name
*
First Name
Last Name
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
-
Month
-
Day
Year
Date Picker Icon
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?
I have SCD/SCT
I care for/about someone with SCD/SCT
Other
How are you affected by SCD/SCT?
I have SCD/SCT
I care for/about someone with SCD/SCT
Other
What type of volunteer position interests you at the moment?
Committee Member (planning &/or execution of events, steady commitment)
Event Volunteer (random commitment)
Other
What type of skills do you bring to SCAK?
What types of SCAK activities interest you?
*
The Gala
Sickle Cell Walk
Pop-up shops
Blood drives
Public Speaking
Media Events
Health Fairs
Community Gatherings
Support Group Meetings
Virtual Events
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 Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Volitional Worker Waiver & Release
Abstention
I DO NOT wish to agree to this consent and understand that I will not be able to volunteer with the Sickle Cell Association of Kentuckiana, Inc. abstaining from this waiver.
Waiver & Release
I affirm that I am of legal age and able to sign on my own behalf and am freely agreeing to the release & waiver of liability. I have read the above linked document and fully understand that by checking this box, I am giving up legal rights and remedies that may be available to me and to other persons.
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.
I DO NOT wish to agree to this consent and understand that I will not be able to volunteer with the Sickle Cell Association of Kentuckiana, Inc. abstaining from this waiver.
Waiver & Release
*
I affirm that I am of legal age and able to sign on my own behalf and am freely agreeing to the release & waiver of liability. I have read the above linked document and fully understand that by checking this box, I am giving up legal rights and remedies that may be available to me and to other persons.
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.
I DO NOT wish to agree to this consent and understand that I will not be able to volunteer with the Sickle Cell Association of Kentuckiana, Inc. abstaining from this waiver.
Digital Signature
First Name
Last Name
Signee relationship to volunteer:
Self
Parent/ Guardian
Today's Date
-
Month
-
Day
Year
Date Picker Icon
Save
Submit
Should be Empty: