Volunteer Sign-UpFill out the form below to volunteer. Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Organization* Gender*FemaleMaleDate of Birth* What area(s) are you interested in volunteering for? Traffic Control Sales Set-up First-Aid Clean-Up Entertainment Other Emergency ContactName PhoneRelationship to Volunteer* Required QuestionsHave you ever been convicted (including entering a plea of guilty or nolo contendere) of any felony crimes with in the past 7 years? Do not include convictions that were sealed or expunged pursuant to a court order.* Yes No Have you been charged with any crime involving a child?* Yes No Do you wish to be recognized as a breast cancer survivor?* Yes No VOLUNTEER LIABILITY RELEASE FORMIn consideration of my desire to serve as a volunteer in relief efforts to be conducted by I hereby assume all responsibility for any and all risk of property damage or bodily injury that I may sustain while participating in any voluntary relief effort or other activity of any nature, including the use of equipment. Further, I, for myself and my heir, executors, administrators and assigns, hereby release, waive and discharge SIA and SI of the Americas and its officers, directors, employees, agents and volunteers of and from any and all claims which I or my heirs, administrators and assigns ever may have against any of the above for, on account of, by reason of or arising in connection with such volunteer relief efforts or my participation therein, and hereby waive all such claims, demands and causes of action. Further, I expressly agree that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the State of Oregon, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I currently have no known mental or physical condition that would impair my capability for full participation as intended or expected of me. Further, I have carefully read the foregoing release and indemnification and understand the contents thereof and sign this release as my own, free act. Are you over 18?* Yes No Parent/Guardian Signature*Release Agreement* I have read and agree to the release above. EmailThis field is for validation purposes and should be left unchanged.
