Volunteer Consent Form

Volunteer Consent Requirement

All volunteers participating in the 2025 Day of Action on Friday, April 25, 2025, are required to complete and sign the official Volunteer Consent Form before taking part in any activities. This form includes a Liability Release and Communications Consent, ensuring that all participants understand the terms of their involvement.

No volunteer will be permitted to participate without a signed consent form.

The form must be completed electronically during registration or submitted prior to the event. If you are under 18, a parent or guardian must sign on your behalf. Any volunteer under the age of 14 must be accompanied by an adult during the event.

If you prefer to complete a hardcopy, you can download the Consent form here and email the signed copy to info@svuw.org.

For any questions or assistance, please contact Danielle Velkoff at (570) 360-5009.

Volunteer Consent Form

Volunteer Contact Information

First Name

Last Name

Company (if applicable)

Phone

(###)

###

####

Emergency Contact

First Name

Last Name

Phone

(###)

###

####

COMMUNICATIONS CONSENT

I hereby assign the rights to the video and/or photographic recording(s) made of me by Susquehanna Valley United Way or its agency(s), hereafter referred to as United Way, to said United Way. I hereby authorize the editing, duplication, reproduction, copyright, exhibition, broadcast, and/or nonprofit use and distribution of said recording(s) for purposes deemed suitable by United Way. I hereby waive any right to approve the finished products. I hereby certify that I am over eighteen years of age and am competent to contract my own name insofar as the above is concerned. I have read the foregoing release, authorization, and agreement, before affixing my signature below and warrant that I fully understand the contents thereof.

LIABILITY RELEASE

I hereby release, indemnify and hold harmless Susquehanna Valley United Way, the organizers, the agency at which I volunteer and sponsors and supervisors of all activities, from any and all liability in connection with any injury (including any injury caused by negligence) in conjunction with Day of Action. I likewise hold harmless from liability any person transporting me to or from any United Way activity. I also certify that I am in good health and able to participate in the program activities during the Day of Action. I certify that I am over eighteen years of age and am competent to contract my name insofar as the above is concerned. I have read the foregoing release, authorization, and agreement, before affixing my signature below and warrant that I fully understand the contents thereof.

PARENTAL CONSENT/RELEASE

If the individual above is a minor (under 18 years of age) the following must be signed by a parent or legal guardian. Any minor under the age of 14 must be accompanied by an adult during the course of this event. That guardian must also complete a separate consent form. I hereby consent and agree, individually and as a parent or legal guardian of, to all the terms and provisions above.

Name

First Name

Last Name

Relationship to Minor

Electronic Signature

By typing your name below, you acknowledge and agree that your electronic signature carries the same legal effect as a handwritten signature. By signing, you acknowledge and accept the terms above. You also confirm that you have read, understood, and voluntarily agree to the terms outlined in the Liability and Communications Release.