A Woman Like You Foundation Volunteer Form

Full Name

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

Employer

Occupation*

Birth Date

MonthDayYear

I prefer to be contacted by

EmailPhone

I would like to receive mail from A Woman Like You Foundation

Email OnlyPostal Mail Only

Do you wish to be recognized as a Breast Cancer Survivor?

YesNo

If you speak a foreign language and are willing to share your skills, please indicate which language.

Why do you want to volunteer for A Woman Like You Foundation in Louisville?

I would like to volunteer. (Please choose all of interest)

Have you volunteered in the past for A Woman Like You Foundation, or any other Breast Cancer Awareness Organization?

YesNo

If so, when?

Please indicate if you have more than one year of experience in the following areas: (You may select multiple areas.)

Please list any additional skills you would be willing to contribute.

How often would you like to volunteer?

WeeklyMonthlyOccasionally

Daytime Availability

YesNo

Evening Availability

YesNo

Weekend Availability

YesNo

Please list any specific details or areas you are interested in volunteering in.

For some events, we offer volunteer t-shirts. What size adult t-shirt do you wear?

EMERGENCY CONTACT NAME

EMERGENCY CONTACT PHONE

RELATIONSHIP TO VOLUNTEER

I understand that as a volunteer, I may become privy to confidential information about a Releasee. I agree to maintain the confidentiality of any information marked "confidential" as well as any information about each Releasee’s business operations, organizational structure, employee information, financial operations, marketing strategy, organization, donor lists and amounts, plans for upcoming events, current or proposed business transactions and sponsorships, and any proprietary information such as computer software and programming and the like that is not otherwise publicly disclosed. I will not use any confidential information in any manner that would be detrimental to a Releasee.

At all times during my volunteer work with A Woman Like You Foundation, I will conduct myself in such a manner as not to reflect unfavorably on or in any way diminish the reputation of A Woman Like You Foundation and its affiliates.

I give my consent and permission to A Woman Like You Foundation and its respective affiliates, successors, licensees, and assigns the irrevocable right to use, for any purpose whatsoever and without compensation, any photographs, videotapes, audiotapes, or other recordings of me that are made during the course of volunteering with an A Woman Like You Foundation Affiliate.

This Release shall be construed under the laws of the state of Kentucky. In the event any provision of this Release is deemed unenforceable by law, (i) A Woman Like You Foundation Affiliate shall have the right to modify such provision to the extent necessary to be deemed enforceable; and (ii) all other provisions of this Release shall remain in full force and effect.

I understand that I have given up substantial rights by signing this Release, and have signed it freely and voluntarily without any inducement, assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of liability to the greatest extent allowed by law.

Volunteer Signature*

Parent's or Guardian's Signature: (If volunteer is under age 18)