2011 VOLUNTEER APPLICATION

PART I.Name ______________________________________________________ Date of Birth _____/_____/_______ Age __________ I certify that I am 18 years of age or older as of 9-17-11.

Address _______________________________________________/_________________________/_____ /_________________Street City State Zip

Primary Contact #: _______________________________________ Alternate Contact #: _______________________________

Email___________________________________________________________________________________________________

Organization/Company Affiliation (if any):_____________________________________________________________________

PART II.TIME PREFERENCEcheck all that apply

AREA(S) OF INTERESTcheck all that apply

Fri., Sept. 16: TBD Set Up (all areas) Sat., Sept. 17: All Day Registration Sat., Sept. 17: 6:00 am – 9:00 am Games Management Sat., Sept. 17: 9:00 am – 12:00 pm Entertainment / Stage Crew Sat., Sept. 17: 12:00pm – 3:00 pm Empowerment Zone Sat., Sept. 17: 3:00 pm – 5:00 pm Security: Stage

Security (all areas) Break-down (all areas)

Saturday, September 17, 2011ParkWest Town Center ● 52nd & Jefferson Streets ● Philadelphia, PA

PART III.I, (print your full name) _________________________________________ certify that I am offering my services to the Jon Drummond Achievement Foundation (JDAF) on a volunteer basis. I understand that I will receive no pay, benefits or other privileges of employment of any kind for my services. I further understand that I am not eligible for worker’s compensation benefits if I am injured or become ill as a result of my volunteer work. I also certify that I have not been promised and have no expectation that I will receive a paid position as a result of my volunteer work.

The undersigned on behalf of themselves and their estate, hereby waives any right of recovery and releases the Jon Drummond Achievement Foundation, their officers, officials, employees and agents, from liability related to or arising from any and all injury to persons and damage to property during the Street Games event. Undersigned further agrees and undertakes to indemnify, hold harmless and defend the JDAF from and against any and all claims, damages, actions, liability and expenses including attorney’s fees and other professional fees in connection with bodily injury including death, personal injury and/or damage to property arising from or out of the Undersigned’s activities and participation in volunteer services at the above Street Games Event. The Undersigned further acknowledges and agrees that the JDAF does not assume any responsibility whatsoever for any property of the Undersigned and the Undersigned shall not hold the JDAF liable for any loss or damage to same. The undersigned gives their permission to be photographed, videotaped and have their image used in Jon Drummond Achievement Foundation publications. Your Signature _______________________________________________ Today’s Date _____________________