Last Name: *  First Name: *

Salutation: Mr. Ms. Mrs. Dr. Other *   If other, please specify:

Email address: *

Phone Number:*
Please check the box next to the number where you can be contacted on the day of the event. HomeOfficeCell

Home
Office
Cell

Constituency: Select one Penn Student Penn Faculty Penn Staff Penn Alumnus/a Sayre Staff Sayre Student Sayre Family Member Neighbor Other  If other, please specify:

Times available to volunteer: (please check all that apply)

Roles
There are several roles for volunteers to play. While we cannot guarantee a particular placement, please let us know if you have a preference for playing one or more of these roles.

Information/Direction (helping people to find particular activities)
Physical Improvement (mainly involving painting, cleaning, etc.)
I have no preference

Would you like to partner with a Sayre School student during the project? Yes No

Special Skills
While no special skills are required for volunteers to participate in the day, please check below if you do have any skills that might help us in the project.

Painting
Landscaping/Planting
Carpentry
Other

If other, please specifiy:

Limitations
Some roles may require physical activity (light lifting, sweeping, etc.). Please let us know if there are activities in which you should not be participating.

Transportation

I would like to take the Penn Bus from campus to the Sayre School
I will get to the Sayre School on my own

Waiver Agreement *
I hereby elect to take part in an activity called the Penn-West Philadelphia Community Partnership Celebration Day, which is offered as an activity sponsored by the University of Pennsylvania. I acknowledge that there may be some risks of injury connected with the activity itself and/or transportation to or from the activity. Further, the potential for injury could be the result of my acts or omissions or the acts of others. In consideration of my being permitted to participate in this activity, I hereby assume all risks and waive any possible claim that I might have against the University of Pennsylvania, it�s trustees, employees, agents, or students in connection with my participation in this activity unless such claims are the result of the sole negligence of the University of Pennsylvania or its employees or agents. I understand that I will continue to be bound by all University of Pennsylvania policies during the course of the Penn-West Philadelphia Community Partnership Celebration Day. I further acknowledge that I am covered by health insurance. By accepting below, I acknowledge that I am accepting this Waiver and Assumption of Risk voluntarily and understand its contents. I have had an opportunity to review it and I may call 215-898-9460 with any questions that I might have concerning its contents.

I accept    I do not accept