Help Make a Positive Impact in Our Community! Join us on Sept. 17 or 20 for a day of volunteer opportunities in support of United Way’s impact partners! See below for project descriptions. Participant Information First name Last name Company/Org (if participating as individual, enter "none") If you are not representing your company/org, please answer none Email (volunteer/project details will be sent here) Email (volunteer/project details will be sent here) Confirm email Phone Number T-shirt size - Select -smallmediumlargeextra large2XL3XL4XL I agree to the terms of service. I grant to United Way of Racine County, including United Way Worldwide and its affiliated organizations, members, successors, assigns and licensees, a non-exclusive and irrevocable right to photograph, record, reproduce, publish, copyright, or otherwise use my name, photographic portraits or pictures, film, videos, internet postings, or sound recordings or any part thereof that may have been taken of me during United Way events and/or activities in written or electronic format, video or film (Content) for promotional, advertising, or other charitable purposes in any media including the world wide web related to the United Way community impact activities. This also includes any tweets or messages through social media. I acknowledge and agree that nothing contained herein requires United Way to use any Content as described herein. I represent and warrant that the consent of no other third party is required to enable United Way to use the Content as described herein, and that such use will not violate or infringe upon the rights of any third parties. I acknowledge and agree that United Way has the right to assign this agreement and/or the rights herein (in whole or in part) to any party. I acknowledge that its sole remedy for any breach shall be an action for damages, and irrevocably waive any right to obtain equitable or injunctive relief. I waive any right of inspection, preapproval, or claims for compensation. I am of full age and have the right to contract in your own name and have read the above consent and permission and are fully aware of its contents. In the event I am a minor, the signature of a parent or legal guardian is required on a photo release form. This Consent and Release contains the full and complete understanding between the parties and supersedes all prior agreements and understandings pertaining hereto and cannot be modified except by a writing signed by each party. Please fill out form separately for each participant (including friends, family, those under 18 you may be signing up for) = Project/Site Choice Please select your project site below: Hospitality Center (Wed, Sept 17, 9:30 am - 12:30 pm) River Bend Nature Ctr (Wed Sept 17, 9:30 am - 12:30 pm) River Bend Nature Ctr (Sat Sept 20, 9:30 am - 12:30 pm) Women's Resource Ctr (Wed Sept 17, 9:30 am - 12:30 pm) Racine Literacy Council (Sat Sept 20, 9:30 am - 12:30 pm) Burlington Senior Ctr (Sat Sept 20, 10 am - 12:30 pm) NAMI Racine County (Wed Sept 17, 9:30am - 12:30pm) George Bray Neighborhood YMCA (Wed Sept 17, 9:30 am - 12:30 pm) Bethany Apartments (Wed Sept 17, 1:30 - 4:30 pm) Bethany Apartments (Sat Sept 20. 9:30 am - 12:30 pm) Racine Family YMCA, Image Mgmt Branch (Wed Sept 17, 1:30 - 4:30 pm) HALO (Wed Sept 17, 9:30 am - Noon) HALO (Wed Sept 17, 1:30 - 4 pm) Racine Zoo (Wed Sept 17 9:30 am - 12:30 pm) Is there anything we need to know to accommodate you or your group? Before you go, did you just volunteer with Women's Resource Center or Bethany Apartments? Please read and check the box below to agree to confidentiality. Thank you! CONFIDENTIALITY PROMISE: I promise I will not disclose any information about any individuals or families I see while in the buildings or offices at Women’s Resource Center/Bethany Apartments. I will not disclose any information about individuals or families that are a part of programs. I understand this confidentiality promise is in effect while I am connected to Women’s Resource Center/Bethany Apartments and is a promise I am making to keep confidential any information about any individual or family forever. I understand this promise also includes identifying any individual or family outside of the Women’s Resource Center/Bethany Apartments as a recipient of service. Leave this field blank
