General Information

Please include at least one phone number where we can reach you during business hours and an email address that you check frequently. Your information will be kept confidential.

First Name: *
Last Name: *
Street:
City:
State:
Zip/Postal Code:
Home Phone:
Work Phone:
Cell Phone:
Email: *
Gender: *
T-Shirt Size: *
At the the time of the event in April, I will be: *
 18 years of age or older Under 18 and my age will be:


How did you hear about us?


Pre-Assigned Tasks: Please indicate if you have already arranged for a specific task with ED@L staff

Emergency Contact

We will attempt to contact the following person in the event of a personal emergency

First Name:
Last Name:
Phone:
Phone 2:
Relationship:

Physical Capabilities or Limitations

Do you have any physical limitations (difficulty standing, lifting, hearing, etc.) that might affect your ability to volunteer? If so, please describe briefly.

Waiver and Release of Liability

In consideration of being allowed to volunteer my services at the EarthDay@Loudoun Family Festival, I hereby acknowledge that there are certain risks of injury involved, and I knowingly and freely assume all such risks and assume full responsibility for my participation.

BY CHECKING THE FOLLOWING "I AGREE" BOX, I UNDERSTAND THAT I AM INDICATING MY AGREEMENT WITH THE TERMS.

I Agree
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