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Official Use DASCO # DATE ASSIGNED: __________

YOU or YOUR Group Leader MUST attend the DO-A-THON Orientation on March 23rd at 2020 NW 1st Avenue – Miami, starting at 10AM. T-Shirts will be provided (There are TEAM colors)

DATE OF APPLICATION: _____/____/____ INDIVIDUAL or GROUP NAME: ADDRESS:

CITY & STATE:

CONTACT PERSON:

E-MAIL ADDRESS:

CONTACT PHONE 1: (___)

CONTACT PHONE 2: (____)

BUSINESS PROFESSION:

NAME (First and Last)

AGE T-Shirt SIZE

NAME (First and Last)

AGE

T-Shirt SIZE

_ _ _ _ _ _ _ _

__ __ __ __ __ __ __ __

Confidentiality Statement: Information concerning donors, clients, employees or fellow volunteers must be treated as strictly confidential. Release of confidential information by unauthorized personnel is grounds for immediate termination of the special event. Confidential information obtained in the course of an event, which is for personal gain, is in violation of our conflict of interest policy and will result in procedures against the said parties. Please be advised of the following conditions: 1. I (we) understand the Broward Outreach Center (BOC) will be held harmless for any group or individuals harmed while on our property and that BOC is not responsible for property of said group or individuals. 2. I (we) understand all media inquiries must be referred to the Communication Department (305-572-2040). 3. I (we) hereby release and approve BOC to take photos of group or individuals while on the premise and to be able to publish them in all of our media output. 4. I (we) agree that any organization, group, or individual planning to hold a special fund raising event for Broward Outreach Center must include the following statement on any publicity, flyers, posters or sign: This event is sponsored by (organization name) for the benefit of Broward Outreach Center. A portion of or the proceeds will benefit the Broward Outreach Center. Your time of arrival for outreach (DO-A-THON) will be given to you by the Volunteer Coordinator Sharde Chambers 305-571-2227 Please arrive on time and report to your appointed team captain for instructions. – Thank you

Signature of Person in authority

Date EMAIL or FAX all applications to: Sharde Chambers Volunteer Coordinator schambers@caringplace.org FAX: 305 571-2245 / Ph: 305-571-2227


Thanksgiving in March Volunteer Application