Repair Affair Volunteer Form

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 *

First Name *

Middle Name

Last Name *

Suffix

Address Line 1 *

Address Line 2

City *

State *

Postal Code *

Primary Phone *

Cell Phone

Work Phone

Email Address *

Current Employer

Gender *

I am currently under the age of 18 *

Date of Birth *

Month

Day

Year

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 *

I have physical limitations Yes, my physical limitation is...

Marital Status *

How did you hear about us

Other

Please rate your skill level at the following tasks.

Carpentry

Concrete

Drywall

Electric

Photography

General Home Repairs

Clerical

Yard Work

Cleaning Gutters

Painting

Plumbing

Please register up to 5 additional family members of your immediate household

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 *

Gender *

Date of Birth *

Month

Day

Year

Second Additional Volunteer

First Name *

Last Name *

Relationship to you *

Gender *

Date of Birth *

Month

Day

Year

Third Additional Volunteer

First Name *

Last Name *

Relationship to you *

Gender *

Date of Birth *

Month

Day

Year

Fourth Additional Volunteer

First Name *

Last Name *

Relationship to you *

Gender *

Date of Birth *

Month

Day

Year

Fifth Additional Volunteer

First Name *

Last Name *

Relationship to you *

Gender *

Date of Birth *

Month

Day

Year

Repair Affair Volunteer Questions

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.

I am signing up as *

My crew leader is *

Crew Leader Email List

Notes

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.

NOTE: All fields with a red asterisk (*) are required.