Virtual Days of Caring Individual Registration

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Thank you for participating in our Virtual Month of Caring event! Please fill out this form regarding yourself:

Volunteer Name: *

Phone number: *

Email: *

Mailing address (so we can send you a Thank You)

T-shirt size: We have Adult: S, M, L, XL, XXL and XXXL *

I can pick up my t-shirt at United Way of Addison County's New office on or after August 26th (Lower Level of Middlebury Fitness, 175 Wilson Road) *

Yes

No, please contact the UWAC office

What you hope to do as your virtual volunteering/organization you would like to support? *

Check off what of these ideas you hope to participate in

Green up your street

Donate blood

Create sidewalk art

Thank a healthcare worker

Random act of kindness

Sew face masks

Deliver food

Financially support United Way of Addison County

Other:

I am willing to send a picture of myself volunteering for use in UWAC's virtual celebration video on September 30, 2020 *

Yes, email to: info@unitedwayaddisoncounty.org

MEDIA RELEASE: I hereby grant permission to the United Way of Addison County to use photographs or video of myself and/or my child(ren) in its official United Way printed publications, PowerPoint presentations or World Wide Web site without further consideration, and I acknowledge the United Way’s right to crop or treat the photograph at its discretion. I also acknowledge that the United Way may choose not to use my photo at this time, but may do so at its own discretion at a later date. *

Yes

LIABILITY DISCLAIMER: In accordance with the spirit of volunteerism and service, I, assume full and complete responsibility for any injury or accident that may occur to me during my voluntary participation in the 2020 Days of Caring activities. Therefore, I hereby release, indemnify, and hold harmless the United Way of Addison County, the organizers, the agency or project site at which I volunteer and sponsors and supervisors of all activities from any and all liability in connection with any injury (including any injury caused by negligence), in conjunction with volunteer activity in the month of September 2020. I acknowledge that there are certain foreseeable and unforeseeable risks associated with participating in this event, including, but not limited to, illness, traveling to and from the event, and the effects of the weather, all such risks being understood and appreciated by me. *

Yes

Any additional questions/information/comments:

Please contact the United Way of Addison County office for any questions or help at: info@unitedwayaddisoncounty.org or 802-388-7189

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