Volunteer Form TitleMr.Ms.Mrs.Dr.Prof.Name* First Last Birthdate* Are you a student?YesNoSchoolAcademy of Information Technology and Engineering AITEDarien High SchoolFairfield UniversityGreenwich AcademyGreenwich High SchoolKing SchoolNew Canaan High SchoolNorwalk Community CollegeRye Country Day SchoolStamford High SchoolOther - Please provide detail belowOther SchoolYour Email* Enter Email Confirm Email Mobile PhoneHome PhoneAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact Name Emergency Contact Relationshipex: mother, friendEmergency Contact PhoneAre you under the age of 18?YesNoYour Parent's/Guardian's EmailIf you are under the age of 18 please provide parent's/ guardian's email address: Enter Email Confirm Email Volunteer InformationPlease list your previous volunteer experience and share with us your interests for volunteering at Building One Community.How did you hear about Building One Community? A Friend A Family Member Newspaper Internet School Another organization B1C Presentation Church Languages you speak: Arabic Chinese English French German Portuguese Spanish Volunteer Skills and Interests: Adult Education Child Education Clerical Computers Cooking Mentoring Soliciting/Event Planning Teaching/Tutoring Immigration Legal Service Other Skills and InterestsAvailabilityPlease indicate what days of the week you are available: Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM Saturday AM Saturday PM Sunday AM Sunday PM Other Information you would like to shareOur Policy:It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. I acknowledge that I have applied to volunteer my services in the programs of Building One Community (B1C), a non-profit community center to help the immigrant community. I acknowledge that I am not an employee of B1C. I understand that while B1C takes seriously the need to provide a safe workplace for staff and volunteers, B1C cannot insulate me from unforeseen circumstances which may cause me harm. I assume the normal risks of such volunteer service and I agree not to hold B1C for such risks, which may include personal injury, property damage or theft. In consideration of the opportunity to volunteer with B1C, I agree on my own behalf and on the behalf of my representatives, assigns, heirs, and kin to waive, discharge, release and further agree not to sue B1C (or its officers, directors, employees, agents or volunteers) from any and all responsibility, liability, claims or actions arising out of or in any way related to my volunteer services at Building One Community. I further consent to the unrestricted use of any photographs, recordings, interviews, videotapes, motion pictures or similar visual recording of me taken in connection with my volunteer services. If an emergency should arise, I understand my responsibility to immediately notify the onsite program facilitator and/or B1C staff and follow their direction. I am aware that the Federal Volunteer Protection Act of 1997 is available for review at: http://www.gpo.gov/fdsys/pkg/PLAW-105publ19/pdf/PLAW-105publ19.pdf Agreement* I have read and agree to the terms and conditions EmailThis field is for validation purposes and should be left unchanged. Please contact us at (203) 674-8585 ext. 120, or email us at [email protected] for any further questions.