Volunteer Form

Volunteer Sign-Up

Fill in the form below to volunteer to support the 2020 Perfect Vision Campaign mobile vision clinic!
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Organization*
Volunteer Type*
Please list your volunteer t-shirt size.*
Emergency Contact Information*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Relationship*
Mother
Volunteer Doctors ONLY

Beginning in 2025, the mobile clinic will be on tour, servicing families between April - October 2025. Please indicate any conflicts.
Please list any conflicts or other information that would be helpful in determining availability

Please provide your availability*

	8am-12pm	10am-2pm	12pm-4pm	3pm-7pm	Not Available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Please include the estimated total MAX volunteer hours you are able to provide in a week.
The safety, health, and wellbeing of the children we service is of utmost importance and our number one priority. As such all volunteers are required to undergo a background check AND complete a Recognizing and Reporting Child Abuse Training for Mandated Reporters. Both must be completed before volunteering with any of our tour stops.*

I agreeI do not agree, and therefore forfeit this volunteer application

Volunteer Liability Waiver

Please review the waiver below and sign.
Waiver & Release

I, desire to volunteer for the Experiences That Matter Foundation's 2020 Perfect Vision Campaign and engage in the activities related to being a volunteer. I understand that the activities may include conducting vision screenings, eye exams, and/or producing prescription eyewear. I hereby freely and voluntarily, without duress, execute this Release under the following terms. I, the Volunteer, release and forever discharge and hold harmless Experiences That Matter Foundation and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my volunteer work. I expressly agree that this Release is intended to be as broad and inclusive as permitted by law. I agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release.
Photo Release

I grant and convey to the Experiences That Matter Foundation all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by the Experiences That Matter Foundation in connection with my volunteer provided services.
Medical Treatment

I hereby release and forever discharge the Experiences That Matter Foundation from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my time as a volunteer.
Insurance

I understand that the Experiences That Matter Foundation does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance of any nature in the event of my injury, illness, death, or damage to my property.
By signing, I acknowledge that I have read and understood all of the terms of this Release.*

Powered by Jotform SignClear
Should be Empty:

Volunteer Sign-Up

Volunteer Doctors ONLY

Volunteer Liability Waiver

Waiver & Release

Photo Release

Medical Treatment

Insurance