Survey - Lace Up for Cancer Volunteer Registration

Your information:


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Street 1: Required
	Street 2:
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
	Phone Number:
	Date of Birth:	Date of Birth:
	If you respond and have not already registered, you will receive periodic updates and communications from South Shore Health.

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Question - Required - Are you over the age of 18?

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Question - Required - Emergency Contact Name:

Question - Not Required - Emergency Contact Phone:

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Question - Required - Date and times you are able to volunteer:

	Friday Afternoon (Time TBD)
	Saturday 5:30 AM - 10:30 AM

Question - Not Required - Would you be interested in volunteering prior to the event if projects arise?

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Question - Required - Do you have any limitations?

Question - Not Required - Have you volunteered at a previous South Shore Health walk?

Question - Not Required - If so, which tasks did you help with?

Question - Not Required - Do you need community service hours?

Question - Not Required - If so, please provide school or organization name:

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Question - Required - By volunteering at the Lace Up for Cancer ("Event") I knowingly, for myself and my heirs, executors and administrators, release, indemnify, hold harmless from, and waive any and all claims, damages, and causes of action, present or future, whether known or unknown, foreseen or unforeseen, arising or resulting from, incident to or as a consequence of my participation in this event, which I may now or hereafter have against South Shore Health and its subsidiaries and affiliates, including the South Shore Health Foundation, the respective Board of Directors, Trustees, staff, volunteers, vendors, agents and other attendees. I intend this to be a general waiver of any and all claims which are in any way related to participation in, or attendance at, this event. I am responsible for my vehicle, my guests, and personal belongings.

I have read the following and agree.

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Question - Required - I will follow any proper guidelines that are currently in place or implemented prior to or at the Event, including but not limited to, CDC and state gathering guidelines. I also grant full permission for organizers to use photographs of me and quotations from me for news stories, promotions and fundraising.

I have read the following and agree.

Lace Up for Cancer Volunteer Registration

Thank You Hero Sponsor

Thank You Guardian Sponsors

Thank You Television Media Sponsor