United Way of Southwestern Indiana

Day of Caring

Volunteer Registration Form

Day of Caring

Friday, September 9, 2011

Breakfast 7:00 a.m.

Inspirational Program 7:30 - 8:45 a.m.

Evansville Arc: 9:00 a.m. - 3:00 p.m. (includes lunch)

Thank you for offering to serve as a University of Evansville Day of Caring volunteer for Southwestern Indiana United Way. United Way has many special needs and each of us has something unique to contribute. Again this year, volunteers from the University of Evansville will be assisting with efforts at Evansville Arc.

Please provide the following information and approval. Return this form to Brian Conner, Office of Residence Life, by August 10. A LIVE UNITED T-shirt in your requested size will be available if you return this form by this date. The final day to register is August 29.

Name______Department______

Telephone______E-mail______

We will need to contact you to share additional information. If you cannot easily be contacted via e-mail or telephone, please let us know how to reach you.

______

Supervisor’s Printed Name______

Supervisor’s Signature______Date______

Volunteer T-shirt Size: M L XL XXL XXXL

Will you be attending the breakfast? Yes No

I plan on working: All Day Morning Only Afternoon Only  These Hours

This year Evansville Arc and Evansville Arc Industries need help with the following projects (please check any that you would be interested in assisting with and circle your first preference):

Evansville Arc – 615 W. Virginia Street
Child Life Center closet organization (6-9 people)
Child Life Center baseboard and cubby cleaning
(3 people)
Adult Day Program music assistant (10 people)
Cleaning Child Life Center windows (6 people)
Painting caution yellow curbing (4-5 people)
Splash Day apparatus construction (4people)
Fence post construction (4people) / Evansville Arc Industries – 2515 Kotter Avenue
Weed landscaped areas around building (4-5 people)
Clean and detail agency vans (4-5 people)
Office remodeling – move everything out of two
offices, pull up carpet, patch holes, paint, lay new
flooring and move furniture back into offices (3-4)
Release of Liability and Photo Authorization and Release:
By checking this box, I affirm that I am the person as stated in the form above and am 18 years of age or older. I do hereby release from liability any persons volunteering/working on projects, owners of property, the city, county, state, and any person associated with the United Way of Southwestern Indiana Day of Caring. In case of emergency, I permit United Way representatives and any person onsite to contact emergency response should something happen to me while volunteering.
I hereby authorize and consent that United Way of Southwestern Indiana shall have absolute right to publish, use, or sell any and all photographic portraits, television spots, or videotapes they have taken of me on September 9, 2011. I hereby waive all claims for any compensation. I hereby warrant that I am of full age and have every right to contract in my own name in the above regard.
 By checking the box, you are agreeing to the above Photo Authorization and Release statement.

LIVE UNITED