What's your email address?

Your information


Required fields are marked with an asterisk (*). One of the fields below is a file upload/attachment, the file size must be less than 10MB.
Birthdate *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
First Name *
Last Name *
Mobile Phone *

For example, 123-456-7890
Address *
If applicable, please tell us the name of your school or organization:
Emergency Contact Name:
Emergency Contact Phone Number:
Emergency Contact Relationship:
Have you volunteered with us before? Please describe your past volunteer experience with our organization or any organizations:
Have you completed a recent TB Skin Test? *
Do you have a Vulnerable Sector Police Clearance?
Why do you want to volunteer with the Alzheimer Society of Windsor -Essex County?
Let us know if you are seeking a specific volunteer position:




Tell us about the volunteer experience you would like to have with our organization including your availability, skills or interests:
Do you any specific qualifications or education that would support your volunteer request:
Have you completed any courses or education in dementia or dementia-friendly communities? Select all that apply:






How did you find out about volunteering?





Is there anything else you'd like to share to support your volunteer application?

Waiver


Who is this registration for?

YOU MUST BE 18 OR OLDER TO SIGN, IF NOT PLEASE ATTEND THIS EVENT WITH A PARENT OR GUARDIAN.

PLEASE READ CAREFULLY BEFORE SIGNING
To: The Alzheimer Society of Windsor and Essex County (ASWE), its employees, Board and Committee members, volunteers, and volunteer leaders (collectively the “Released Parties”)
As a Releasee, I fully understand and agree to the following:
Assumption of Risks: Participation in events involves various risks, dangers and hazards, which all volunteers and vendors are required to assume. The Releasee hereby freely accepts and fully assumes all such risks, dangers and hazards and the possibility of personal injury, death, property or loss resulting from participation.
Release: In consideration of being granted permission to participate in the event, the Releasee hereby for itself, its heirs, executors, administrators, or any others who may claim on its behalf, covenant not to sue, and hereby waive, release and discharge the Alzheimer Society of Windsor and Essex County and the Released Parties from any and all claims of liability for personal injury, illness, loss of life or property damage of any kind or nature, arising out of or sustained in the course of the Releasee’s participation.
Indemnity: In consideration of being granted permission to participate in the event, the Releasee agrees to hold harmless and indemnify the Alzheimer Society of Windsor and Essex County and the Released Parties from any and all liability, loss, claims, demands, costs and expenses, including reasonable legal fees, due to any personal injury or property damage to any third party, arising from the Releasee’s participation in the event.
Consent to Use: In consideration of being granted permission to participate in the event, the Releasee grants the Alzheimer Society of Windsor and Essex County, and anyone it may authorize, its consent to use its likeness, voice, words, or any other representation, as well as any works of art it may furnish [collectively the “Works”] in television, radio, film, print, or in any other form, and the right to reproduce, display, distribute, and record same, to promote the event and any other future promotions as may be determined by the ASWE. The Works may or may not identify the Releasee as the subject and/or author, and the Releasee waives any rights that it may have to inspect or give its approval to the Works.
Personal Items: Releasee are fully responsible for their own personal items during the event, including but not limited to any equipment, materials, works of art, or personal effects that they may use in the course of their Participation and the Released Parties shall not be liable for any loss of or damage to the same. Any items kept on site are done so at the Releasee’s own risk.
I, ON BEHALF OF THE RELEASEE, AM AWARE OF THE NATURE AND EFFECT OF THIS ASSUMPTION OF RISKS, RELEASE, AND INDEMNITY AND FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT THE RELEASEE HAS GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.