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

LEADING TOGETHER2012-2013PROGRAM DATES:

Personal & Contact Information

Employment & Education Information

Person to Notify in Case of Emergency

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

(please check all that apply)

How did you learn about the Y-WE?

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

Special Skills, Talents or Qualifications

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:

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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