Volunteer Survey

Question Title

* 1. Please Provide Your Contact Information Below

Name *

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address *

Phone Number *

Question Title

* 2. How did you hear about PD Gladiators?

Friend, family member

Healthcare professional

Community event

Support group

Other (please specify)

Question Title

* 3. What is your connection to Parkinson's disease?

I have PD

I am a care partner to someone with PD

I have a family member who has PD

I have a friend who has PD

No direct connection - I just want to help!

Other (please specify)

Question Title

* 4. What volunteer opportunities are you interested in?

Fitness class assistance

Fundraising

Event planning

Case management - phone calls and emails to participants

Community outreach - tabling at local events

Media and marketing

Grant writing

Administrative support

Clinical outreach - visiting neurology offices, distributing materials

Corporate sponsorship solicitation

Graphic design work (brochures, newsletters, website, social media ads)

Other (please specify)

Question Title

* 5. How much time do you have to dedicate to your volunteer opportunity?

1-3 hours per week

1-3 hours per month

As much time as PD Gladiators needs. I'm flexible!

Other (please specify)

Question Title

* 6. What are you hoping to get out of your volunteer experience with PD Gladiators?

Question Title

* 7. Please review and acknowledge the following disclaimers:

As a volunteer for PD Gladiators, I agree to abide by all applicable rules and regulations of the organization.

I understand that PD Gladiators may need to check references and/or complete a criminal background check depending on participation and interest.

I hereby release and waive liability against PD Gladiators, Inc., a non-profit corporation, its board of directors, officers, employees and agents, its successors and assigns, for any injuries or illness that I may suffer in connection with any volunteer work for PD Gladiators.

I agree that PD Gladiators, Inc., is not liable for any damage to my property resulting from volunteer work for PD Gladiators.

I certify that my answers on this application are true and complete.