* Required Information Personal Information Name * Date of Birth* Email * Cell Phone Home Phone Work Phone What is the best way to contact you? Home Phone Work Phone Cell Phone E-mail Address * Emergency Contact Information Emergency Contact Relationship Phone Number Additional Information / Availability What days are you available to volunteer? Monday Tuesday Wednesday Thursday Friday Saturday Sunday What time of the day are you available to volunteer? Morning Afternoon Evening Are you a student volunteering to fulfill a certain amount of community service hours? Yes No If you answered 'Yes' above, please fill out the following: Name of School Hours needed Deadline date to complete the required hours Interests / Qualifications Tell us in which areas you are interested in volunteering Advocacy Clerical/Data Entry Community Services Exhibitions/Art Handling/Gallery Sitting Events Computer/Technical Fundraising Mailings Off-Site Opportunities Skills / Qualifications Physical / Medical Limitations TERMS AND CONDITIONS Volunteer Agreement In agreeing to this liability waiver, I certify that I am a willing participant in the Newark Arts Council volunteer program. I agree to work according to instructions I receive. I agree to behave in a responsible manner. I agree to perform only work that I feel comfortable in doing and that I feel I can accomplish safely. Permission – Use of Photographs I grant permission to use individual and group volunteer photographs, films and videos of me for promotional or other uses furthering the mission of the Newark Arts Council, including use on the NAC website. Acknowledgement and Assumption of Risk I recognize that the opportunity to participate in the Newark Arts Council volunteer program may involve physical labor and may carry a risk of personal injury and I hereby agree to assume all risks which may be associated with my participation. I hereby release, discharge, waive and relinquish all claims, liabilities and damages I may sustain from bodily injury, personal injury or property damage and hold harmless the Newark Arts Council, its officers, directors, employees and agents. CONSENT By checking this box, I acknowledge that I have read this form and fully understand that by signing this form I am giving up legal rights and/or remedies which may otherwise be available to me regarding any losses I may sustain as a result of my participation.