Harambee Community Action Day: Please Return As Soon As Possible

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Harambee Community Action Day

Volunteer Registration Form


PLEASE RETURN AS SOON AS POSSIBLE*
PLEASE PRINT
Volunteer Name: _____________________________________________________________

Address: ____________________________________________________________________

City: ______________________________________________ State: _____ Zip: __________

Home Phone: (_) __________ Cell Phone: (_)__ ________ Office Phone: (_) ____________

Email address: _______________________________________Gender: __ Male __ Female


Age of Volunteer: _____ Adult (age 18 or older)* *T-Shirt Size: __S __M __L __XL
_____ Youth (age 17 or younger)* __ XXL __XXXL
* We will do our best to accommodate all requested t-shirt sizes. Your signature releases Harambee
Community Action Day Organizers from all liability. Youth volunteers must have authorized
signature of parent/guardian to participate in meetings and serving as volunteers for this event.

__________________________________________________________________________
*Print Name of Volunteer
__________________________________________________________________________
*Signature of Volunteer
___________________________________________________________________________
*Print Name of Parent/Guardian of Youth Volunteer
__________________________________________________________________________
*Signature of Parent/Guardian of Youth Volunteer
Please select a volunteer area below. If selection is not made, you will be automatically
assigned to an area of need by the Volunteer Coordinator.
Volunteer Self Assignment: Volunteer Committee Assignment:
_____ Food Committee _____ Food Committee
_____ Volunteer Committee _____ Volunteer Committee
_____ Youth Committee _____ Youth Committee
_____ Resource Information Committee _____ Resource Information Committee
_____ Environmental Committee _____ Environmental Committee
_____ Day of Event/Traffic Flow Committee _____ Day of Event/Traffic Flow Committee
_____ Set-Up/Clean-Up Committee _____ Set-Up/Clean-Up Committee
RETURN FORM TO:
MS. HENRIETTA ALLEN, DIRECTOR
Interfaith Older Adult Programs, Inc.
Clinton Rose Senior Center
3045 North Dr. Martin Luther King, Jr. Drive
Phone: 414-534-1898
Fax: 414-263-1460
HCAD VRF 2010 Edition: 050310 Revised 052010

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