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