Gus Macker Volunteer Form 2023
Email *
First Name *
Last Name *
Mobile phone number *
Address *
City *
State *
Emergency Contact Name *
Emergency Contact Relationship *
Emergency Contact Phone Number *
Any allergies or special accommodations needed? *

Please indicate what days and times you are interested in volunteering. A committee member will be in contact to discuss shift times

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Required
What times are you available? (If multiple dates are selected please list times for each day) *
Please indicate what area(s) you will be most comfortable
 *
Required

Photo Release

I grant permission to Sylvester Broome Empowerment Village and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release the Sylvester Broome Empowerment Village and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that were given during an interview or guest lecture, with or without our names, for the purpose of advertising and publicity without restriction. I waive my rights to any compensation.

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Please type your name for permission.

By typing my name I confirm that all the information is accurate to the best of my ability.

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Please type your name.
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