Volunteer Application

Your Name

Your Email

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone

Length of Residence in PA

Branch

Date of Birth

Ethnicity

Age Range

gender

Are you a member of the YMCA of Greater Pittsburgh?

Yes

Is this a Community Service Requirement?

Yes

If Yes, How Many Hours?

VOLUNTEER OPPORTUNTIES: For which position(s) are you applying? * Visit www.pittsburghymca.org/volunteer to see a list of all available volunteer opportunities.

VOLUNTEER SKILLS: What special talents or skills do you have that you would like to utilize?

From time to time, as part of the YMCA Volunteer Program, the YMCA and YMCA volunteers are photographed for marketing purposes, engaged in writing or art projects for promotion and publication, highlighted in news stories (newspapers, radio and/or television), and other projects where you could be photographed, interviewed, or otherwise recognized for your involvement in the program. MARKETING AND MEDIA PERMISSION AND RELEASE: I give permission to be photographed, interviewed, quoted, and/or receive recognition for my work and involvement while participating in the YMCA Volunteer Program.

Emergency Contact 1 First Name

Emergency Contact 1 Last Name

Emergency Contact 1

Emergency Contact 2 First Name

Emergency Contact 2 Last Name

Emergency Contact 2

EMERGENCY MEDICAL TREATMENT:

I hereby agree

In the event emergency medical aid/treatment is required due to illness or injury during the process of receiving services or while being on the property of the agency, I authorize the YMCA of Greater Pittsburgh to secure and retain medical treatment and transportation if needed.

Signature of Volunteer

Sign above

Date of Volunteer Signature

First

Last

Signature of Parent/Guardian if Under 18 Years Old

Sign above

Date of Parent/Guardian Signature

RELEASE AND WAIVER OF LIABILITY: I hereby accept any and all responsibility for, and assume the risk of any and all injury or damage to my person that might arise directly or indirectly as a result of, and or participation as a volunteer for the YMCA of Greater Pittsburgh. I hereby expressly release, discharge and hold harmless from any liability whatsoever the YMCA of Greater Pittsburgh, the various branches and subdivisions thereof, and all employees and volunteers in their capacities as representatives of the YMCA of Greater Pittsburgh. I give my consent that any photographs, videos, interviews, etc. of myself or my family may be used in promotional material such as brochures or newspaper releases. I understand that I will not be given notice or reimbursed for such photographs.

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