NOTE: All fields with a red asterisk (*) are required. New or Returning Volunteer Volunteer Type * NEW VOLUNTEER - I am a NEW volunteer. (Also select this option if you were previously volunteering under a parent/guardian and would now like to register yourself individually.) UPDATE VOLUNTEER - I am a RETURNING volunteer but I would like to update my emergency contact information, medical limitations, skill levels, or other volunteer information. CURRENT VOLUNTEER - I am a RETURNING volunteer and all of my information is up-to-date. Primary Contact Information Title * - Select -Mr.Mrs.Ms.Dr.Rev.RabbiSisterPastorFather First Name * Middle Name Last Name * Suffix - None -Jr.Sr.IIIIIIVEsq.M.D.D.D.S Address Line 1 * Address Line 2 City * State * - Select -AlabamaAlaskaAlbertaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Postal Code * Primary Phone * Cell Phone Work Phone Email Address * Current Employer Gender * - Select -MaleFemale I am currently under the age of 18 * - Select -YesNo Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 PWC takes your privacy as a volunteer very seriously. We will never sell, loan, trade or otherwise release your personal information. Volunteer Registration Information Emergency Contact Name * Emergency Contact Phone * Emergency Contact Relationship * I have physical limitations * - Select -I have no physical limitations.Yes, my physical limitation is... I have physical limitations Yes, my physical limitation is... Marital Status * - Select -MarriedSingleSeparatedDivorcedPartnerWidowerWidowOther How did you hear about us - None -A Friend or Family MemberChurchWorkTelevisionRadioNewspaperMagazineRoadside billboardSocial Media website, like Facebook or TwitterVolunteer website, like www.volunteermatch.org Other Please rate your skill level at the following tasks. Carpentry - None -1-Willing to learn2-Some experience3-Skilled (I do my own home repairs)4-Highly Skilled (I am a professional) Concrete - None -1-Willing to learn2-Some experience3-Skilled (I do my own home repairs)4-Highly Skilled (I am a professional) Drywall - None -1-Willing to learn2-Some experience3-Skilled (I do my own home repairs)4-Highly Skilled (I am a professional) Electric - None -1-Willing to learn2-Some experience3-Skilled (I do my own home repairs)4-Highly Skilled (I am a professional) Photography - None -1-Willing to learn2-Some experience3-Skilled (I do my own home repairs)4-Highly Skilled (I am a professional) General Home Repairs - None -1-Willing to learn2-Some experience3-Skilled (I do my own home repairs)4-Highly Skilled (I am a professional) Clerical - None -1-Willing to learn2-Some experience3-Skilled (I do my own home repairs)4-Highly Skilled (I am a professional) Yard Work - None -1-Willing to learn2-Some experience3-Skilled (I do my own home repairs)4-Highly Skilled (I am a professional) Cleaning Gutters - None -1-Willing to learn2-Some experience3-Skilled (I do my own home repairs)4-Highly Skilled (I am a professional) Painting - None -1-Willing to learn2-Some experience3-Skilled (I do my own home repairs)4-Highly Skilled (I am a professional) Plumbing - None -1-Willing to learn2-Some experience3-Skilled (I do my own home repairs)4-Highly Skilled (I am a professional) Register More People Please register up to 5 additional family members of your immediate household 012345 Register up to five additional family members or members of your immediate household. These individuals will participate under your registration and waiver and you must have legal responsibility over any minors you are registering. First Additional Volunteer First Name * Last Name * Relationship to you * - Select -HusbandWifeSonDaughterPartner Gender * - Select -FemaleMale Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Second Additional Volunteer First Name * Last Name * Relationship to you * - Select -HusbandWifeSonDaughterPartner Gender * - Select -FemaleMale Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Third Additional Volunteer First Name * Last Name * Relationship to you * - Select -HusbandWifeSonDaughterPartner Gender * - Select -FemaleMale Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Fourth Additional Volunteer First Name * Last Name * Relationship to you * - Select -HusbandWifeSonDaughterPartner Gender * - Select -FemaleMale Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Fifth Additional Volunteer First Name * Last Name * Relationship to you * - Select -HusbandWifeSonDaughterPartner Gender * - Select -FemaleMale Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Repair Affair Volunteer QuestionsPlease look carefully for your Crew Leader, or by the Crew name. If your crew leader is not listed, please choose the "I do not know who my crew leader is" and type their name in the note section below. I am signing up as * - Select -Repair Affair Crew LeaderRepair Affair Volunteer - I Have a CrewRepair Affair Volunteer - I Don't Have a Crew My crew leader is * - Select -I do not know who my crew leader isI am signing up to be a crew leaderAlex Gerschutz -- Northpoint DevelopmentAndrew Cross -- Danis ConstructionAnne-Marie Alexander -- CABRBill Sedwick -- Christ Church GlendaleBill Pearce -- St Anne Episcopal ChurchBob Trusty -- Team TrustyBrent Barnes -- First Financial BankCaleb Kingsley -- Michelman IncCharles Thrasher -- Friends of CharlieCraig McKee -- WCPODan Kurtz -- Danis ConstructionDave Castellini -- Dave's GroupDerek McCain -- City of CincinnatiDon Wilson -- Don's GroupEmily Price -- Magnum PieringErika Lundstedt -- Junior League CincinnatiErin Rehkamp -- TKOR HoldingsGeoff Ryan -- ACI YPGwendelyn Keihl -- Johnson Investment CouncilHelen Kitts -- Hope ChurchJamie Humes -- Home Builders AssociationJason Verhoff -- Park National BankJean Swartley -- Cincinnati Mennonite FellowshipJeremy Lawson -- Awesome LawsonsJess Lawrence -- Madeira CommunityJoe Lee -- ConstructConnectJohn Lupidi -- Danis ConstructionJohn Westerkamp -- Pioneer Cladding GlazingJosh Viox -- Omnia360Julie Bogusz -- KPMGMallory Dodd -- Thermo FisherMark Caesar -- BB-TMark Maciejewski -- Al. NeyerMartin Sutton -- BSA Troop 974Maxwell Ponting -- UC CSAMichelle Caridi -- EmergeMitch Hudepohl -- Danis ConstructionNakul Narendran -- UC College of MedicineNathan Arnold -- HixsonPaul Ackerman -- Jacobs EngineeringRyan McLane -- DBL LawRyan Warner -- Girl Scouts Unit 486Ryanne Mitchell -- Dedicated Senior Medical CenterScott Kaylor -- IntegraSharon Watkins -- Community Action AgencyStephanie Lambers -- TriHealth 4/22/2021Stephanie Lambers -- TriHealth 4/26/2021Stephanie Lambers -- TriHealth 5/1/2021Sue Paul -- Side By SideTim Sprague --_Temple SholomTom Schuetz -- Fifth-ThirdTom Westrich -- Tom and Diane's TeamVic Black -- Anderson Hills UMC Please look carefully for your Crew Leader, or by the Crew name. If your crew leader is not listed, please choose the "I do not know who my crew leader is" and type their name in the note section below. Crew Leader Email List - None -agerschutz@northpointkc.comandrew.cross@danis.comannemarietheagent@gmx.comwsedwick90@gmail.comlabpearce67@gmail.combob@trustymail.netbrent.barnes@bankatfirst.comCaleb.kingsley@gmail.comcatthr@fuse.netnewstwome@gmail.comdannykurtz81@gmail.comdac1@fuse.netderek.mccain@cincinnati-oh.govdewpilot@cinci.rr.comeprice@magnumpiering.comlundstedt.erika@gmail.comerinrehkamp@tkorholdings.comgryan@terrexllc.comgkeihl@johnsoninv.comkittsh@pwchomerepairs.orgjhumes@traditionsgroup.comjason.verhoff@parknationalbank.comsjrodenberg@gmail.comjeremylawson330@gmail.comjessolaw@gmail.comJoe.Lee@constructconnect.comjohn.lupidi@danis.comjwesterkamp@pioneerglazing.comjviox@omnia360fs.comjbogusz@kpmg.comdodd.mallory7@gmail.comMCaesar@BBandT.commmaciejewski@neyer.comMartin.Sutton@L3Harris.compontinma@mail.uc.edumcaridi@emergeits.commitch.hudepohl@danis.comnarendnl@mail.uc.edunarnold@hixson-inc.compaul.ackermann@jacobs.comrmclane@dbllaw.comRyanne.Mitchell@dedicated.carescott.kaylor@integralife.comStephanie_Lambers@trihealth.comStephanie_Lambers@trihealth.comStephanie_Lambers@trihealth.comsuepaulrph@gmail.comreneeandtimsprague@gmail.comThomas.Schuetz@53.comtodee995@cinci.rr.comvicblack60@gmail.com Notes COVID-19 Safety Protocols for PWC Volunteers and Staff• We will do outdoor work only, and will have no direct contact with PWC clients. • We are limiting crew sizes in order to maintain a safe distance while working. For larger groups, we'll ask you to break up into multiple teams. • All volunteers will wear face coverings while on a job site. PWC can provide as many cloth face coverings as you need. We will also work with you to make sure there are mobile hand-washing stations and hand sanitizer at each job site, in addition to any other PPE needs like gloves or safety glasses. • Every crew leader will participate in a jobsite safety training to make sure every team has the tools they need to work safely while preventing the spread of COVID-19. This training will be offered virtually and in person. Acknowledgement and Acceptance of COVID-19 Safety Protocols * I have read and understand the above protocols and agree to follow COVID-19 safety guidelines while volunteering for PWC. Contact Preferences and Legal Releases Communication Preferences Please put me on your mailing list I would like to get e-news from PWC I am interested in information about social, networking and volunteer events for Young Professionals Minor Release * I am under the age of 18 and have the permission of my parent or guardian to volunteer who does hereby release and hold harmless People Working Cooperatively, Inc., their funders, supporters, officers, agents and employees and the homeowner for whom I am doing home repairs for any major injury which I may suffer or incur as the result of my volunteering. I am over the age 18 and do hereby release and hold harmless People Working Cooperatively, Inc., their funders, supporters, officers, agents and employees and the homeowner for whom I am doing home repairs for any major injury which I may suffer or incur as the result of my volunteering. Photo Release * By volunteering, I allow PWC to use my image/photograph for agency promotional purposes Medical Insurance * I understand that volunteers who submit this form are covered up to $1,500 in medical insurance related to their specific volunteer duties Client Privacy * I understand that PWC takes the privacy of our clients very seriously. We request that volunteers never breach a client's privacy or the confidentiality of a client's record. Legal Release * By submitting this form, I do hereby release and hold harmless People Working Cooperatively, Inc., their funders, supporters, officers, agents and employees and the homeowner for whom I am doing home repairs for any injury which I may suffer or incur as the result of my volunteering. Please note, these waivers and releases shall remain in effect for all PWC volunteer activities.