Walk for the Cause volunteer Sign Up

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Organization*

Gender*

Date of Birth*

What area(s) are you interested in volunteering for?

Traffic Control
Sales
Set-up
First-Aid
Clean-Up
Entertainment
Other

Emergency Contact

Name

Phone

Relationship to Volunteer*

Required Questions

Have you ever been convicted (including entering a plea of guilty or nolo contendere) of any felony crimes with in the past 7 years? Do not include convictions that were sealed or expunged pursuant to a court order.*

Yes
No

Have you been charged with any crime involving a child?*

Yes
No

Do you wish to be recognized as a breast cancer survivor?*

Yes
No

VOLUNTEER LIABILITY RELEASE FORM

In consideration of my desire to serve as a volunteer in relief efforts to be conducted by I hereby assume all responsibility for any and all risk of property damage or bodily injury that I may sustain while participating in any voluntary relief effort or other activity of any nature, including the use of equipment. Further, I, for myself and my heir, executors, administrators and assigns, hereby release, waive and discharge SIA and SI of the Americas and its officers, directors, employees, agents and volunteers of and from any and all claims which I or my heirs, administrators and assigns ever may have against any of the above for, on account of, by reason of or arising in connection with such volunteer relief efforts or my participation therein, and hereby waive all such claims, demands and causes of action. Further, I expressly agree that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the State of Oregon, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I currently have no known mental or physical condition that would impair my capability for full participation as intended or expected of me. Further, I have carefully read the foregoing release and indemnification and understand the contents thereof and sign this release as my own, free act.

Are you over 18?*