Register by completing this form and returning it to Town Hall. Email:
. Fax: (585) 336-7276.
Reset Form
Submit Form
Print Form
Invigorate Irondequoit: 2018 Volunteer Registration Form Register by completing this form and returning it to Town Hall. Email:
[email protected] Fax: (585) 336-7276 Mail: 1280 Titus Avenue, Rochester, NY 14617 Questions? Call (585) 336-6029 All registration forms must be received by F r i d a y, April 27th Walk-In Registrations are Welcome
T h e F i r s t 100 Volunteers to Check-In will R e c e i v e a F r e e T - S h i r t ! Please note: Each individual volunteer that plans to participate in Invigorate Irondequoit: 2018 must submit a signed form. Full Name: ______________________________ Phone: _________________________ Address:________________________________________________________________ Email:________________________________________ Group or Community Organization Name (if applicable):____________________________ Interested in becoming a Project Leader: Yes No Project Leaders coordinate volunteer activities at a specific site. Community Groups or Organizations are * encouraged to become project leaders and oversee a site/project. Specific Skills? (construction, gardening, landscaping, etc.):________________________________________________ NOTICE TO VOLUNTEER & AGREEMENT BY VOLUNTEER I understand that I am not an employee of the Town of Irondequoit (“Town") and will not receive payment for my volunteer services. I will not represent myself as an employee of the Town and understand that as a volunteer, I am not covered by the workers' Compensation Laws of New York State. As a volunteer I agree to take full responsibility for my own actions, safety and welfare. I agree to release, indemnify and save harmless the Town, its officers, officials, agents, employees, successors and assigns, from and against any and all liabilities, actions and causes of action which may arise, directly or indirectly from my participation as a volunteer. 1 further understand that as a volunteer I am not allowed to operate any power equipment, drive Town vehicles, handle Town funds, supervise Town employees, provide "life guarding" services or use/handle pesticides, herbicides or other hazardous chemicals. I declare that all the information provided on this application is true, and 1 understand that any falsifications or misrepresentation may result in my termination from the Town's volunteer program. I give permission for my image to be used for Town's publicity of the event. I understand that Town staff and volunteers may be photographing individuals and groups during the cleanup. Are you 18 years old or older?
Yes
No (If "No" - Parent or Guardian must sign below)
Signature: ________________________________________ Date:_______________________ *We will not sell or share your name or contact information
