Individual Special Olympics Volunteer Registration

Volunteer Type*:

First Name*:

Last Name*:

Cell Phone*:

no spaces or hyphens

Email Address*:

T Shirt Size:

Are you 16 years of age or under?

Yes No

I am interested in volunteering for the 2013 Fall Festival in 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:

   I am CPR certified
   I am First Aid certified
   I am 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 complete the Waiver Form below.

All persons under the age of 18 must have a parent or guardian
sign the waiver form below. We invite all ages to cheer on the
athletes at competition, but those under the age of 18 will need
to be accompanied by an adult.

If you have additional questions, please feel free to contact us.
Please complete the WAIVER FORM

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:

PARENT/GUARDIAN SIGNATURE

I, as a parent or guardian of the above applicant, have read and agree with all of the
provided information and hold Special Olympics Pennsylvania and/or its volunteers and
employees harmless for any negligence resulting in injury, illness or accident that may occur
during my charge's participation.

Parent Signature:

Date: