Waterfire Volunteer Form

Attention Registered Volunteers: Click here for updated volunteer information (directions, meeting information, etc.)

Thank you for your interest in volunteering. Registration for this year’s Flames of Hope… A Celebration of Life at Waterfire on October 10 th has now ended. However, we are still taking information for alternates as well as information for those interested in volunteering next year. If you wish to register to be an alternate or if you wish to be notified via mail or email next year, please enter your information below. If you are selected to be an alternate volunteer, we will contact you prior to the event.

Thank you again for your continued support, and remember…it’s your fight too!

Name* (First and Last):
Birthday*:	(MM/DD/YYYY)
Address:
City:
State:
Zip:
Primary Phone: (Best # to reach you)
Primary Phone Type:	Cell Home Work Other
Alternate Phone:
Alternate Phone Type:	Cell Home Work Other
Email*:
Re-enter Your Email Address *:

Are you a breast cancer survivor?


	Emergency Contact Information:
In the event of an emergency, who should we notify*:
Relationship to you*:
Emergency contact phone number*:

Friend/Family/Organization Affiliation
If you would like to be placed with friends/family or with volunteers from a particular organization, please list them here. Please note, we cannot guarantee that you will be placed with everyone you list here. However, we will make every attempt to keep groups of friends, co-workers and group organizations together when placing volunteers.
Organization:
Family/Friend's Name:
Family/Friend's Name:
Family/Friend's Name:
Family/Friend's Name:


	How Did You Find Out About This Event? (Check all that apply)
I know someone in the foundation:
I know someone at Gem Plumbing & Heating:
College/Student Organization:
Business/Work Organization:
I visited the Gloria Gemma Resource/Wellness Center
I am a Breast Cancer Survivor
I know someone with cancer
I attended last year's event
I volunteered last year
I heard it on the radio
Internet/website
I saw it in a magazine
I work at Gem Plumbing
Other:

Volunteer Areas
Most shifts last anywhere from 6 to 8 hours; however some are longer and some are shorter.

Please select the hours that best suit your availability.
10/09/09 Setup (Day BEFORE the Event) 5PM - 9PM
10/10/09 Setup (Day of Event) 7AM - 2PM
10/10/09 Waterfire Event 11AM - 11PM
10/10/09 Waterfire Event 7AM - 5PM
10/10/09 Waterfire Event 3PM - 11PM

RAIN DATE: Sunday Oct., 11th 2009
I can work the rain date, during the same hours
I cannot work on the rain date

2nd RAIN DATE: Saturday Oct., 17th 2009
I can work the rain date, during the same hours
I cannot work on the rain date

Setup: Includes (but may not be limited to) the following job functions: Lifting, Bending, Walking, Pushing, Pulling, Standing for long periods of time, Climbing, Overhead lifting, Reaching, Working on ladders, Stooping, Kneeling, Crouching, Handling, Repetitive use of hands and feet, Grasping

The Waterfire Event Areas: Includes (but may not be limited to) the following job functions: Lifting, Bending, Walking, Grasping, Handling, Repetitive use of hands and feet and Standing for long periods of time

Do you have any physical limitations that may prevent you from participating in any activities*?

Comments:

How did you hear about being a volunteer?

Radio
TV
Email Campaign
Phone Call

Friend
Newspaper
Flyer
Other

VOLUNTEER MEETING

Volunteer Meetings: Each volunteer needs to attend one meetings. At the meeting, we will review job functions, hand out maps, Volunteer T-shirts and parking passes, and answer any other questions you may have that evening. The meetings will be held at Gem Plumbing & Heating, 1 Wellington Road, Lincoln, RI 02865. Tentatively, the meetings are scheduled for:

Tuesday, October 6th, 2009 5:30pm – 7:30pm

DIRECTIONS:
From South: 95 north to 146 north. Take exit for Break Neck Hill Road (Rte 123). Take left as end of ramp and follow to light. Go straight through light about 1.9 miles you will see Powder Hill Road on right. Take this right and follow around curve. Wellington Road is your first right. We are the first building on right. The agency head is in Gem Plumbing and Heating Company.

From North: 146 South. Take exit for Break Neck Hill Road (Rte 123). Take right as end of ramp and follow to light. Go straight through light about 1.9 miles you will see Powder Hill Road on right. Take this right and follow around curve. Wellington Road is your first right. We are the first building on right.

We will be handing out volunteer T-shirts, parking passes, a map of the area as well as letting you know where you will be working on the day of the event.

If you have any further questions, please call the Volunteer Hotline at 401-459-4400.

Terms and conditions of volunteering: As a volunteer for the Gloria Gemma Breast cancer Resource Foundation, I understand the nature of the type of work involved. I understand that the type of work that I may be performing may include physical activity, contact with unidentified or unfamiliar individuals or other potential risk of bodily injury or property damage. Knowing this and in consideration of being chosen to volunteer, I assume full responsibility for any bodily injury or property damage that I may sustain or cause during my participation as a volunteer. I hereby release the Gloria Gemma Breast Cancer Resource Foundation, hold harmless and covenant not to file suit against the Gloria Gemma Breast Cancer Resource Foundation, any of its sponsors, affiliated agents, employees, contractors, volunteers, or board members, from any and all loss, liability or claim that may arise out of my service as a volunteer. I also understand that as a volunteer, I may, from time to time, see and hear confidential information about the Gloria Gemma Breast Cancer Resource Foundation. I agree to maintain the confidentiality of any information marked confidential, as well as any information about the Gloria Gemma Breast Cancer Resource Foundation not deemed for public use. I also agree to maintain all confidential information about event participation and volunteers, nor would I disclose any information that would be detrimental the Gloria Gemma Breast Cancer Resource Foundation.

Signature:
Date: (MM/DD/YYYY)
I agree to the terms and conditions above*

This will serve as your digital signature that you understand the terms and conditions set forth in the Gloria Gemma Breast Cancer Resource Foundation volunteer agreement

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The Gloria Gemma Breast Cancer Resource Foundation is a 501 (c) 3 tax emempt non profit organization as recognized by the Internal Revenue Service.

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