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Volunteer Application
  • Position: Office Volunteer
    Date / Time: Fri Feb 19th '10 9:00 a.m.-12:00 p.m.
    Location: Komen Office 7412 University Ave. #2

    Form MUST be completed BEFORE volunteering for any Komen event or volunteer position.
    Name:
    Do you want to be recognized as a breast cancer survivor?
    Yes No Years
    Mailing Address:
    City:
    State:
    Zip:
    Home Phone:
    Business Phone:
    Cell Phone:
    Email:
    Date of Birth: (mm/dd/yyyy)
    Emergency Contact:
    Phone:
    Relationship to Volunteer:
     
    WAIVER:
    I wish to volunteer for Susan G. Komen for the Cure. I understand that the nature of volunteer activities that I may perform in my capacity as a volunteer may involve physical activity, contact with unidentified and/or unfamiliar persons, or other potential risk of bodily injury or damage to property. Knowing this and in consideration of being allowed to volunteer, I HEREBY ASSUME FULL AND COMPLETE RESPONSIBILITY FOR ANY PERSONAL INJURY AND/OR PROPERTY DAMAGE THAT I SUSTAIN OR CAUSE DURING MY PARTICIPATION AS A VOLUNTEER. IN ADDITION, I HEREBY RELEASE, HOLD HARMLESS AND COVENANT NOT TO FILE SUIT AGAINST SUSAN G. KOMEN FOR THE CURE. I understand that as a volunteer, I may become privy to confidential information about Komen or its affiliates. I agree to maintain the confidentiality of any information marked "confidential" as well as any information about Komen's or its affiliates' internal procedures, business operations, personnel information and the like that is not otherwise publicly disclosed by Komen or its affiliates. I will not use any confidential information in any manner that would be detrimental to Komen or its affiliates, and I will avoid any actions that might impair the reputation of Komen or its affiliates.

    I understand and accept the terms of the waiver.
    I am at least 18 years of age.
    I am NOT at least 18 years of age*
     
    *If volunteer is NOT at least 18 years of age, parent or legal guardian
    MUST print out and sign the bottom of this volunteer form.