Volunteer Application for Young Women Empowered

Volunteer Application for Young Women Empowered

Please look over our program dates and events and consider which days and times would work best with your schedule. Many jobs—likeprepping bagged lunches for meetings and admin work in our office—can be completed outside of the schedule listed below. This is just for your reference.

HER STORIES 2012-2013 PROGRAM DATES: All events at Seattle Reparatory Theater

Date / Time / Activity
2012
Sept 29 / 12:00-4:00 pm / potluck, meet and greet, basic info
Oct 6 / 11am-6:30pm / Show, lunch and workshop
Nov 17 / 11am -6:30 pm / Show, lunch and workshop
Dec 8th / 11:00 am-6:30 pm / show, lunch and workshop
2013
Feb 2nd / 11:00am-6:30pm / Show, lunch and workshop
March 16th / 11:00am-6:30pm / show, lunch and workshop
April 6th / 2:00 -6:00 pm / Workshop only--script for girl's show will be presented
May 4th / 11am-6:30pm / show, lunch, and workshop
May 11th / 1:00 pm-6:00 pm / rehearsal of show
May 18th / 11:00 am-8:00 pm / Tech, rehearsal and performance
International Dinner / TBA time, date and location

LEADING TOGETHER2012-2013PROGRAM DATES:

Date / Time / Activity
2012
Oct 20 / 1:00-4:00 pm / Short kick off (info, open house, meet and greet)
Nov 16-18 / 11/16 5:00 pm – 11/18 4:00 pm / Opening retreat likely at Camp Korey
2013
Jan 19 / 12:00 pm-5:00 pm / Neighborhood House
Feb 9 / 12:00 pm-5:00 pm / Neighborhood House
March 9 / 12:00 pm-5:00 pm / Neighborhood House
April 19-21 / 4/19 5:00 pm – 4/21 4:00 pm / Final retreat likely at Camp Korey.
International Dinner / time, date and location TBA

Personal & Contact Information

Full Name
Mailing Address
City ST ZIP Code
Home Phone
Cell Phone
Work Phone
E-Mail Address
Birth Date
Do you identify as a person of color? ___ yes ___ no / Ethnicity (optional):

Employment & Education Information

Employer
Length of Employment
Job Title
May we contact you at work? / ___ yes ___ no
Would you be willing to offer a job shadowing opportunity for a young woman? / ___ yes ___ no
Education Completed / ___ High School ___ College ___ Other:
College Degree(s) in
Name of School
Post Graduate Degree(s) in
Name of School

Person to Notify in Case of Emergency

Name
Phone Numbers
E-Mail Address
Relationship to you

Volunteer Interests: Tell us in which areas you are interested in volunteering

(please check all that apply)

___Drive Girls to and from Programs
___ Help prepare and deliver lunches to meetings
___ Assist with set up and clean up
___ solicit and collect in-kind donations from local businesses
___ Help with annual international dinner
___ Participate in career day
___ Help cook at our retreats
___Help with Admin and Data-entry work in our Redmond office
___ Other volunteer Ideas:

How did you learn about the Y-WE?

What are some reasons why you would like to be involved?

Special Skills, Talents or Qualifications

These can include arts; business and entrepreneurships skills; healing and self-care practices; nature awareness; college prep; technology, marketing, and media skills; cooking; crafts; sewing; and much more!

Time Commitment: Our schedule of 2012-13 events is included on the very first page. Please list the dates, times, or event that you would most like to be assigned:

References: Please list two non-family members who can serve as references for you:

Name
Phone Numbers
E-Mail Address
Relationship to you
# of years he/she has known you
Name
Phone Numbers
E-Mail Address
Relationship to you
# of years he/she has known you

Hold Harmless Release Form

PLEASE initial each line, by hand (do not use the computer for this page).

I am willingly signing up to volunteer for this Young Women Empowered Program

I hereby hold harmless Young Women Empowered (Y-WE) and Partnership for Youth Empowerment (PYE), its employees, officers and agents, and any leaders of Y-WE and PYE from any and all responsibility and liability of any nature that may arise during the program, from circumstances beyond Y-WE/PYE’s control.

Insurance: It is the responsibility of every individual to provide for her own accident and health coverage while participating in all Y-WE activities. I understand that Y-WE does not provide any accident or health coverage for its volunteers.

Valuables: I understand that personal items that are misplaced or lost at Y-WE’s program are the responsibility of the participants and volunteers, NOT Y-WE or PYE. ______

Photo and Video Release: I give permission for Y-WE or those who have the written consent of Y-WE to use photos or videos of myself for purposes of promoting future Y-WE programs. I expressly release Y-WE, your agents, employees, licensees, and assigns from any and all claims which I have or may have for invasion of privacy, defamation, or any other cause of action arising out of the use of these photographs and video. ______

I certify that the information I have supplied is correct to the best of my knowledge. I grant permission for Young Women Empowered to contact the references provided. I also agree to hold Young Women Empowered and those persons who are contacted in connection with my application harmless from any legal claim regarding compliance with the request for references. ______

I also agree to have Young Women Empowered conduct a criminal background check with the Washington State Patrol. (This is required for anyone who works with youth.)______

Name (please print) ______

Signature Date ___

Please email the first four pages to

Please return page 5 (Hold Harmless Release Form), with your signature, to:

Jamie-Rose Edwards

Young Women Empowered

P.O. Box 1681 Duvall, WA 98019

Questions?

Contact Volunteer Jamie-Rose at: (425) 941-0574

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