Special Olympics Volunteer Group Registration

Volunteer Type*:

Group Name*:

Contact First Name*:

Contact Last Name*:

Cell Phone*:

(no spaces or hyphens)

Email Address*:

Number of T-Shirts:

Small Medium Large
X Large XX Large

Number of Members:

Number of Members Under 16:

My group is interested in volunteering for the 2013 Fall Festival
for the following shift(s):
NOTE: We encourage volunteers to sign up for more than one shift.
We will try to accommodate your preferences, however, positions cannot be guaranteed.

Position:

Position Descriptions

Will you go off campus?
(Shuttle provided)

Yes No

Comments:

Friday, November 1:

   1:00pm - 3:00pm (NOTE: Competitions begin at 2 PM)
   3:00pm - 5:00pm
   5:00pm - 7:00pm
Opening Ceremonies begin at 7:30 (open to public)

Saturday, November 2:

Sunday, November 3:

   7:00am - 9:00am
   9:00am - 11:00am
11:00am -   1:00 pm

Special Requests:

Physical Impairment (Crutches, walkers etc)
Wheelchair Accessibility Need

Certifications:

   Are any of your members CPR certified?
   Are any of your members First Aid certified?
   Are any of your members willing to be a Medical Volunteer?

Thank you for your support! We will confirm with you the exact date, time, and volunteer opportunity you selected for your group via email.

Please ensure that you have each member complete our Waiver Form. Send a copy of this pdf to each member in your group or the url of the online waiver form.

All persons under the age of 18 must have a parent or guardian
accompany them and sign the waiver form.

If you have additional questions, please feel free to contact us.

As the Group Leader, please complete the WAIVER FORM below for yourself - send
the link to the online waiver form or the pdf version or word version to your
members and bring all completed printed pdf waivers for your group the event day.

First Name:

Middle Initial:

Last Name:

Date of Birth:

Mailing Address-Street:

Mailing Address-Apt:

Mailing Address-City:

Mailing Address-County:

Mailing Address-State:

Mailing Address-Zip:

Day Phone:

Evening Phone:

FAX:

E-Mail:

Occupation:

Group Affiliation:

Group City:

Group State:

Group Zip:

Employer/School Name:

Employer/School Street:

Employer/School City:

Employer/School State:

Employer/School Zip:

What year did you begin volunteering with Special Olympics, PA:

IN THE EVENT OF AN EMERGENCY, PLEASE CONTACT.

Name:

Relationship:

Day Phone:

Evening Phone:

VOLUNTEER SIGNATURE

I affirm that I have read, that I understand and that I will adhere to the volunteer
responsibilities and code of conduct; that the information I have given is true and
complete. If at any time the information provided is found to have been knowingly falsified,
I will be disallowed from volunteering for any program accredited by Special Olympics
Pennsylvania.

By typing your name below, you agree that this constitutes a legal signature and
you hereby accept the terms of this waiver.

E-Signature:

Date:

Drivers License Number:

Student ID Number:

Other ID Number:

What Type of Other ID: