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Youth Waiver


	Be the Change. Volunteer.

Welcome to the HandsOn Greater Phoenix Member Registration.

Use the form below to register as a volunteer for HandsOn Greater Phoenix projects, courses, and special events.

* denotes a required field

Member Registration Form

First Name *
Last Name *
Date of Birth *
	mm/dd/yyyy
We require date of birth for verification of eligibility with affiliate projects/activities and for demographic reporting for funders.

Mailing Address *
Address Line 1 *
Address Line 2
City *
State *
Zip code *
Region

Main Phone Number *		Type*
Other Phone Number		Type

Place of Employment

Your login information will be:

Email Type *

E-mail Address *

Re-Enter E-mail Address*

Password *

Re-Enter Password *

Sign me in Automatically

Click here if you have a disability.

Gender

Race

Education Level

Marital Status

How did you hear about us?

	Arizona Republic			Business Journal
	East Valley Tribune			print media- other
	television- other			KTAR 620 AM
	radio- other			internet search
	bookstore newsletter			friend/co-worker
	company/organization			CBS 5/Power of 5
	Hands On Network Web site			Postcard/Flyer
	Disney 'Give A Day.' Program			Facebook/Twitter/LinkedIn
	Changing Hands

Availability

	Weekdays (Monday - Friday)
	Weeknights (Monday - Friday)
	Weekends (Saturday - Sunday)
	Weekdays & Weekends
	Weeknights & Weekends
	All / Anytime
	I am available to work on short notice for important volunteer needs

Terms and Conditions

In connection with my voluntary involvement in activities undertaken for, and with the participation and support of Make A Difference, a non-profit, 501(c)3 organization, I hereby agree, for myself, my heirs, assigns, executors, and administers to release and discharge Make A Difference, its officers and directors, employees, agents, and volunteers from all claims, demands, and actions from injuries sustained to my person and/or property as a result of my involvement in such activities, whether or not resulting from negligence, and I agree to release and hold Make A Difference, its officers and directors, employees, agents and volunteers harmless from any cause or action, claims or suit arising therefrom.  I hereby attest that my attendance and involvement in such activities is voluntary, that I am participating at my own risk and that I have read the foregoing terms and conditions of this release.  I also grant full permission for Make A Difference to use photographs of me and quotations form me in legitimate accounts and promotion of Make A Difference activities.

I hereby confirm, represent and warrant that I have never been convicted of, or charged with, a violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape or any sexual offense, nor have I been ordered by a court to received psychiatric or psychological treatment in connection therewith.

I agree I disagree


5151 N 19th Avenue, Suite 200 • Phoenix, AZ • 85015 • P 602-973-2212 • F 602-973-9233	AN AFFILIATE OF