UNITED WAY OF CALVERT COUNTY

United Way of Calvert County banner with blue background and white text

United Way Volunteer Resource Center
2007 Volunteer Release Form

Users can submit this page online by clicking the submit button found at the end of the form,
print and fax, or print and mail the form. Upon receipt of completed form, the United Way will contact you with further details. If you have not received a response in 5 business days, please call our office.

Phone: 410-286-0100
Fax: 410-535-8987
Postal: P.O. Box 560 Prince Frederick, Maryland 20678

Agencies are required to keep a copy of this form at the project site on Day of Caring. Originals are to be returned to the United Way office.

General Information
Tee Shirt Size:
Name of Volunteer:
Agency Where You Volunteered:
Employer:
Home Address: We never release your personal data.
City/State/Zip:	/ /
Work Phone:	Ext.
Work Email:
Home Phone:
Home Email:
Emergency Contact: Phone:

I hereby release, indemnify, and hold harmless the United Way of Calvert County, the organizers, sponsors, and supervisors of all its activities, from any and all liability in conjunction with any injury, in conjunction with the 2007 Day of Caring events held at local United Way agencies or other designated sites on Wednesday, September 12, 2007 or designated rain date. I likewise hold harmless from liability any person transporting me to or from any United Way activity. I consent to the use of photographs/video taken of me on the 13th Annual Day of Caring for the express purpose of contributing to a public relations endeavor by United Way of Calvert County. I understand that these photographic/video materials may be used by the United Way for publicity, including fund raising campaigns, now or in the future, and I will receive no compensation for photographs/video materials or my statements in conjunction with the United Way of Calvert County’s Day of Caring.

Signature:	Date:
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