The Promise Walk for Preeclampsia

Volunteer Form

First Name

Last Name

Address

City

State

Zip

Cell phone
(can be reached on day of event)

What location are you volunteering for?

Date of birth

T-shirt size:
Small Medium Large X-Large XX-Large

Do you have any special interests or skills that could be helpful as a volunteer for the event
(Example: bilingual, computer technician, very organized, 'people person' etc)

Do you have any physical restrictions that should be considered for your volunteer assignment?
(Example: cannot lift anything over 10 lbs, heat sensitive etc)

Please help us avoid spam by answering this simple question:

What month comes after May?

I understand and agree that submitting this application form does not automatically register me as a Preeclampsia Foundation volunteer, and that there may be certain qualifications I must meet, including the acceptance of the following established volunteer policies and procedures before I may begin volunteering:

Code of Conduct:
I desire to serve as a volunteer with the Preeclampsia Foundation (the "Foundation") and help further its stated mission.

As a volunteer, I understand that I may be exposed to confidential information that is defined as inside, personal or sensitive information, and may include contact information, health information, or personal experience stories. By agreeing to this Code of Conduct, I am prohibited from sharing or disclosing this information for any unauthorized purpose, including personal benefit.

In all situations in which the Foundation is involved, I promise to conduct myself according to the standards set forth in the Preeclampsia Foundation Volunteer Handbook (available at http://preeclampsia.org/get-involved) and I understand that it is my responsibility as a volunteer to remain professional, respectful and discreet at all times.

I acknowledge that I have access to the electronic version of the Volunteer Handbook and understand the contents of the Volunteer Handbook. I have now, and in the future, the opportunity to ask and receive answers to any questions I have about the contents of the Volunteer Handbook.

I also understand that I must disclose any of my outside interests that may be in conflict or competition with the interests of the Foundation or that stand to benefit from my involvement therewith, and then refrain from participating in any discussions pertaining to those conflicts.

I understand that the Foundation is not financially or otherwise liable for injury or casualties that occur to anyone while serving as a volunteer for the Foundation.

I hereby grant the Foundation specific permission to reproduce, publish, circulate, copyright, or otherwise use any and all photographs and/ or videotape of me and/or my family taken at any volunteer event, for use by the Foundation.

CODE OF CONDUCT CERTIFICATION AND DISCLOSURE
By clicking "Submit" on this application, I certify that I have read and understand the Preeclampsia Foundation's Code of Conduct, I have the opportunity to download and read the Volunteer Handbook at any time, and I agree to comply with the terms therein, as well as applicable laws that impact the Foundation. I also understand that should I not maintain the conduct outlined above, the Foundation reserves the right to terminate my voluntary position immediately. I also have the right to step down from my volunteer position at any time.