UCEA Programs Volunteer Application

Application Date

Date

Full Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Birthdate

Date

If during your time volunteering there is an emergency, who would you like us to contact?

Emergency Contact Relationship, Name, and Phone Number.

Do you have any physical restrictions?

If you have any restrictions, please list them below.

Volunteer Interests

I would like more information on...

Availability

Do you have to complete any Community Service hours?

If so, explain below.

Please communicate why you need community service and how many hours you need.

Why do you want to volunteer with us?

Liability Waiver

I will not hold United Churches Elizabethtown Area (UCEA) or its employees, interns, officers, representatives, the board of directors, any other programs associated with UCEA, or any fellow volunteers liable for accidents, injuries or death to myself, my child, or any other person for whom I am lawful guardian, that may result from any volunteer activities sponsored by, arranged, or participated in by UCEA and its programs. Neither will I nor any person for whom I am lawful guardian hold liable the persons who operate UCEA and its programs' equipment during volunteer activities for accidents, injury, or death that may result from UCEA activities. Photography/Videography Release The undersigned hereby consents to be photographed or videotaped and agrees to allow United Churches Elizabethtown Area (UCEA) and its programs to use any photo or video to be used for future promotional purposes. I understand that I will receive no remuneration if any photographs, images, actions, or voice are used in UCEA brochures, advertisements, or visual presentations. I understand the context in which my photo or video may appear in this promotion/publication and also consent to all purposes of the reproduction or use of this photo or video by UCEA in all manners, rights that I may have with, or in, the distribution or use of this photo reproduction.

Check here to show you accept the terms stated above for yourself or for a minor Volunteer for which you are the parental guardian.

Signature