2017 Day of Caring Senior and Homebound Project Registration Form Due September 18, 2017
Complete the information below: Name of Person completing form(if different than below): ______
Name of Recipient:______Referring Agency______
Address:______City:______State:______Zip______
Phone Number:______Alternative Contact Phone # ______
2. Emergency Contact & Phone Number: ______(Family or friend’s name) (Phone number)
3. Read and sign the release of liability statement:
I hereby release and hold harmless United Way of Richland-Wilkin and the organizers, sponsors and supervisors of all its activities, from any and all liability in connection with any injury (including any injury caused by negligence) received in conjunction with the 2017 event held on Tuesday, October 3, 2017
______(Senior’s signature) (Date)
4. Photo Release (check one):
Yes, United Way of Richland-Wilkin has permission to use my name and photographs/videos for publicity purposes. No, United Way of Richland-Wilkin does not have permission to use my name and photographs/videos for publicity purposes.
COMMUNICATIONS RELEASE: I hereby assign the rights for video and /or photographic recording(s) made of me on Tuesday, October 3, 2017 participating in volunteer activity by United Way of Richland-Wilkin or its agencies. I hereby authorize the editing, duplication, reproduction, copyright, exhibition, broadcast and or nonprofit use and distribution of said recordings for purposes deemed suitable by United Way.
I hereby waive any right to approve the finished products. I certify that I am over eighteen years of age and am competent to enter into this release. I have read the foregoing releases, authorizations, and agreements, before affixing my signature below and warrant that I fully understand their contents.
Signature______Date______
Name (please print):______
Phone:______E:Mail______TURN OVER TO COMPLETE OTHER SIDE. THANK YOU Project Some projects may include painting a room, cleaning out a flowerbed, sorting canned food, cleaning out and wiping down cupboards, cleaning ceiling fans, shampooing carpets, moving furniture, cleaning the garage, washing walls, trimming hedges or any projects that will assist you with your home care. Estimate of how many volunteers are needed? Minimum____ Maximum ______
Projects to be done: (Describe in detail the project. For example; How many windows to wash, What type of furniture to be moved; etc.)
The Senior will need to provide the needed supplies for the project. Thank you
Please have an alternative “indoor” project if there is inclement weather and we are not able to work on outside projects Alternative Indoor Project in case of inclement weather:
6. Mail by September 18th to: United Way of Richland-Wilkin PO Box 746 Wahpeton, ND 58075 Contact Colette at the United Way with any questions. 642-1250 email [email protected] website: www.unitedwayrw.org **United Way will provide the volunteers with lunch so you do not need to plan meals for them. This is a free helping hand for you, we celebrate a community coming together for one another.
What is Day of Caring?
Day of Caring is a mobilization of volunteers to celebrate the spirit of giving through service by providing a day of meaningful volunteer opportunities to individuals of the community. Volunteers are assigned to assist the seniors and homebound folks of our community and tackle meaningful volunteer projects.
Some projects may include painting a room, cleaning out a flowerbed, or sorting canned food, cleaning out and wiping down cupboards, cleaning ceiling fans, shampooing carpets, moving furniture, cleaning the garage, washing walls, trimming hedges or any projects that will assist you with your home care.
When is Day of Caring? Tuesday, October 3, 2017 8:30am(Registration) 9:00am Start projects throughout the day until 3:00pm.
Who will the volunteers be participating in the Day of Caring?
Businesses, employee groups from local corporations, church groups, youth groups, civic and philanthropic groups, United Way supporters, and any caring individual. Everyone is welcome to perform community service tasks to help fellow community members.
Why is Day of Caring so important?
Day of Caring demonstrates that volunteer efforts are vital to the well being of our community. Day of Caring provides volunteers with a firsthand look at needs that make an impact on people’s lives. Day of Caring showcases our communities’ volunteer efforts and promotes the spirit of caring throughout the year. Day of Caring provides many community members with much-needed volunteer assistance. Day of Caring is a great team building exercise for families, service organization or employees.