Summit Volunteer Times

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Thank you for volunteering for our upcoming Healthy Aging and Fall Prevention Summit. Please select from the times below according to your availability. This will allow staff to plan accordingly to make sure all stations are covered. You will receive a confirmation email of the times you selected. All selections are confirmed unless you receive a call from Healthy Aging Association.

The event this year will be in-person at the Modesto Centre Plaza on Friday, October 13th from 8:00am - 1 pm.

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電子郵件 *

First Name *

Last Name *

Organization Name (if applicable)

Street Address *

City *

Zip Code *

Phone Number *

Emergency Contact Name *

Emergency Contact Phone Number *

T-Shirt Size *

Small

Medium

Large

X-large

2X-Large

3X-Large

Friday, October 13th

7:00 am - 9:00 a.m. - set up

9:00 a.m. - 11:00 a.m.

11:00 a.m. - 1:00 p.m.

1:00 p.m. - 2:00 p.m. - clean up

Available for the entire event 8:00 a.m. - 1:00 p.m.

Areas of Interest (select all that apply)

Volunteer Check In - assist volunteers in getting checked in and direct them where they will be stationed

Vendor Check In - assist vendors in getting check in and direct them where their booth is located

Event Evaluation Table - assist attendees in completing the event evaluation form

Food Table - assist will restocking snacks and drinks

Screening Station - assist with checking in attendees for screenings

Greeter - assist with greeting attendees and directing them

Raffle - assist with organizing the raffle prizes and announcing winners

Distribute produce bags - working outside to pass out bags of fruits and vegetables

Would you be willing to help make reminder calls to potential attendees from the comfort of your own home? (lists and scripts will be provided) *

Yes

WAIVER: understand that this is an application for and not a commitment or promise of volunteer opportunity, nor am I obligated to accept a position offered. CONSENT TO PHOTOGRAPH/RECORD I hereby authorize the Healthy Aging Association, and affiliated not-for-profit organizations to permit news media and other representatives to photograph or film me and agree they may use, or permit others to use, tapes, films, or prints, prepared there from. I agree that the above named organizations, their employees, and agents, shall not be responsible in any way for the content of news media coverage in which the photography authorized herein is used. HOLD HARMLESS AGREEMENT The undersigned shall hold the Healthy Aging Association, and affiliated not-for-profit organizations, their agents, officers, directors, employees, consultants, and their successors, and volunteers harmless from and save, defend and indemnify them against any and all claims, losses, liabilities and damages from every cause, including but not limited to injury to person or property or wrongful death, with the indemnity to include reasonable attorney’s fees, and all costs and expenses, arising directly or indirectly out of any act or omission of the undersigned, whether or not the act or omission arises from the sole negligence or other liability of aforementioned Agencies, or its agents, employees, or volunteers relating to or during the performance of its obligations under this agreement. I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between myself and the Healthy Aging Association, and affiliated not-for-profit organizations and sign it of my own free will. Minor Volunteer Authorization: If you are under 18 years of age PLEASE CALL OUR OFFICE (209)525-4670 prior to signing. *

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