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volunteer on SEPTEMBER 7, 2013 at Monclova Elementary School 8035 Monclova Road

6:30 a.m. -1:30 p.m.

Please fill out the information below. Each volunteer will receive a FREE t-shirt. Thanks!

Volunteer name:

Date of Birth: Month

City, State, zip

-

E-mail address: YS

YM

YL

Individual

Volunteering as:

S

M

L

XL

XXL

XXXL

Entire Shift

Assignment preference:

Parking

1st Shift

Emergency contact:

Emergency phone number:

Group Group name:

Will you require any type of personal health/physical accommodations?

Volunteer for:

Year -

Phone number:

Address:

T-shirt size:

Day

2nd Shift

Registration (18yrs & older)

No

Yes

-

-

Explain:

(*Assignment will be determined 1st by shift available, 2nd by assignment preference.)

5K Assignments

Walk Route Assignments

Companion on Walk

Children's Area

I waive the right to hold Sunshine Inc. of Northwest Ohio, Sunshine Foundation, Inc., Monclova Township or any sponsors or individuals associated with this event responsible for any and all injuries, loss or theft that may occur to me or my vehicle while participating in any events related to the Walk, 5K Run & Roll on Saturday, September 7, 2013. I attest that I am physically able to participate in this event. I acknowledge that I have read and fully understand my own liability and do accept these restrictions. Electronic signature will be considered an official and legal signature.

X

(Parent or guardian if under 18)

Please e-mail completed registration to: volunteer@Sunshine.org

* Please send in forms by AUGUST 16th to guarantee your shirt.

If you have any questions please contact: Rania Haynes 419-794-1369 or previous email.


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