Service Hours Needed - Saturday, April 19th, 2014 from
11am - 4 pm (with a few people staying until 4:30 to help us load up the trucks and do clean-up)

Event Location - McKenzie Stadium
2205 NE 138th Ave., Vancouver, WA 98684
behind Evergreen High School

Contact Information - John Krejcha at john@autismempowerment.org or by phone at 360-852-8369. On event day, contact 360-601-4678 (cell)

Question Title

* 1. Name

Question Title

* 2. What is your age?

Question Title

* 3. Autism Serves number? (This is Autism Empowerment's Volunteerism Program)

If you have an Autism Serves number, please enter it here. If not, one will be assigned.

Question Title

* 4. Have you Volunteered with Autism Empowerment in the past?

Question Title

* 5. What is your full address with City, State and Zip code?

Question Title

* 6. Phone number(s) that are best to reach you?

Question Title

* 7. What is the best e-mail address to reach you at?

Question Title

* 8. In case of Emergency, please provide contact information.

Question Title

* 9. Do you have any limitations that we should be aware of or do you need any accommodations?

Question Title

* 10. What is your Shirt size? All sizes are Adult. (100% cotton shirt.)

Question Title

* 11. Are you part of a group that will be volunteering at this event?

Question Title

* 12. Does the Group or Company that you work for have a Volunteer Program? (Some companies will pay you for volunteering and/or make a donation to our organization if you volunteer. Win/Win!)

Question Title

* 13. If you are part of group, which group?

Question Title

* 14. Please list the contact name for your group? Please provide as much information as possible (name, e-mail, phone).

Question Title

* 15. What would you like to do to help?

Question Title

* 16. Will you need somebody to verify hours worked?

Question Title

* 17. Do you want to be on the Autism Empowerment mailing list for other volunteer opportunities? (We can use help in a lot of different areas throughout the year!)

Question Title

* 18. Release and Waiver of Liability

1. Waiver and Release: I release and forever discharge and hold harmless Autism Empowerment, Miracle League of Vancouver, Innovative Services NW and its successors and assigns from any and all liability, claims and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from my participation as a volunteer for the Easter Egg Hunt for Acceptance of All Abilities. I understand and acknowledge that this Release discharges the Nonprofit from any liability or claim that I may have against the Nonprofit with respect to bodily injury, personal injury, illness, death or property damage that may result from participation in this event.

2. Photographic and Copyright Release: I grant and convey to Nonprofit listed above all right, title, and interest in any and all photographs, images, video or audio recording of said volunteer or likeness or voice made by the Nonprofit in connection with the Easter Egg Hunt. I further grant and convey to the Nonprofit all rights, title and interests in any and all work, including but not limited to photographs, images, video, audio recording taken and/or produced in connection with the Easter Egg Hunt. This release covers Autism Empowerment, Miracle League of Vancouver, Innovative Services NW or any other agent of the nonprofit.

** Required to be let into the event.

T