Application — Reading Empowers

APPLICATION

We are so excited that you would like to join us! Please fill out the volunteer application form below and someone will contact you soon!

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Date of Birth

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Occupation

Experience in working with children:

What Inspires you to promote literacy?

School Preference

Grade Preference(s):

Would you be willing to complete a background check?

Please provide one or more references:

Name, Relationship, and Phone Number

Emergency Contact

Name, Relationship, and Phone Number

Volunteer Agreement / Waiver

As a volunteer of Reading Empowers, Inc. ("REI"), I hereby agree to hold harmless and waive any and all claims or causes of action against REI arising out of any cause whatsoever, including but not limited to claims arising out of negligence or intentional conduct of its employees or agents. I attest that I am physically and mentally fit and prepared to perform the tasks assigned to me as a REI volunteer. I agree to indemnify and hold harmless REI for all claims arising out of my participation as a REI volunteer. I acknowledge that REI has not arranged and does not carry any insurance of any kind for my benefit. I further agree to use my personal insurance as the primary provider in the event of injury due to my work as volunteer for REI. REI is no responsible for loss or damage to volunteer's personal property. I also grant permission to REI and its employees, staff members, and volunteers to take and use visual / audio images of me. Visual / audio images are any type of recording, including photographs, digital images, drawing, renderings, voice sounds, video recordings, audio clips, or accompanying written descriptions. Such images will only be used in the promotion of REI. I understand that this document is intended to be as broad and inclusive as permitted by the laws of the state of New York and agree that is any portion of this Agreement is invalid, the remainder will continue in full legal force and effect. I am at least 18 years of age and competent to sign this release / waiver. I have read this release / waiver before signing. I understand its contents, and I freely accept the terms.