2025 Volunteer Registration Form

Information

Name First and Last:

Date of Birth:

Gender:

Male Female

Address

Email:

This address will receive a confirmation email

Phone:

Parents Name (If under 16)

Parents Phone (if under 16):

Emergency Contact During Event:

Emergency Contact Phone:

A current background check is required for ALL volunteers over the age of 16.

I have had a background check within the last 12 months by EastSide:

Yes No

If no, please click this link to complete a background check: https://esbcmh.breezechms.com/form/8d151a1529

If you are under the age of 16, a permission slip signed by your parent/guardian is required to volunteer. Please Click on this link:https://esbcmh.breezechms.com/form/b1cdf6351667

Special Skills/Training (Please Click All That Apply) Fluent in American Sign Language (ASL) Special Education Teacher Healthcare Professional Other

I Have Volunteered at Night to Shine Before:

Yes No

Additional Notes or Concerns:

The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (“activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant or otherwise.

Agree

2025 Volunteer Registration Form

Description

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