A Walk to Stamp Out Parkinson s Volunteer Application Personal Information Name Address Suite Apt City Home Phone Cell Phone ___________________________ __________________________________________ ___________________________State Zip ______ Work Phone Email Experience and Education Describe any previous experience as a volunteer type of organization and kind of work you performed Current Employer Name Does your current employer have check all that apply Donation matching program Not applicable Program for volunteering Your Interests at The Parkinson Council How did you learn about Stamp Out Parkinson s Radio Ad Print Ad Website Poster brochure College University Council Employee Current Volunteer Other P l e a s e s p e c i f y _____________________________________ Do you have interest in volunteering at other Parkinson Council events Yes No Skills you would like to use while volunteering Billboard A Walk to Stamp Out Parkinson s Saturday October 8 2016 MLK West River Drive You have a choice of day of volunteer positions Please specify your preference s Ambassador Make walkers feel welcome and direct them to amenities food t shirts etc 7 30 9 00 AM Cheerleader Share your energy by cheering walkers along the route 8 00 11 00 AM Set Up Clean Up Volunteer This is a great team building activity for groups May require moderate lifting 6 00 7 30 AM Set Up 10 30 AM 11 30 AM Clean Up T Shirt Distributor Hand out free t shirts to all participants 7 30 9 30 AM Movement Central Help set up for demonstrations of movement programs for people with Parkinson s disease e g Dance for PD Yoga 7 30 AM 11 00 AM Crossing Guard Guide walkers entering and leaving walk area at pedestrian crossing points 7 30 AM 11 00 AM shifts available Photographer s Assistant Help with Walk Team photos 7 30 AM 11 00 AM Optional Do you have any special needs or restrictions we should be aware of Yes No As a participant in A Walk to Stamp Out Parkinson s I agree to release all claims or demands against The Parkinson Council sponsors or any personnel for any injury I might suffer in this event I grant full permission for organizers to use photographs of me and quotations from me in legitimate accounts and promotions of this event Print Name Signature Date Must be signed by a parent or guardian if volunteer is under 18 years of age Please return this form to ahaung theparkinsoncouncil org The Parkinson Council s 111 Presidential Blvd Suite 141 s Bala Cynwyd PA 19004 Phone 610 668 4292 s Fax 610 668 4275 s walk theparkinsoncouncil org