2011 Happy Kids Day Teen Volunteer Registration Form

www.happykidsday.org
Organized by: Taiwanese Volunteer Group (Non-profit organization) Sunday

Event Date: August 28, 2011

Time: High School Student Volunteer Hours, 7:00am 19:00pm

** High school student volunteers will be offered service hours.

Event Site: 10800 Torre Ave. Cupertino CA 95014, Cupertino Library Field
Registration: Mail-in applications , or e-mail to : mark@taiwanesevolunteer.org Registration Deadline: August 15, 2011 (A confirmation will be sent via email.) Mail Recipient & Address: Happy Kids Day, 10789A S. Blaney Ave., Cupertino, CA 95014

Cut Here------Mail it to HKD / Will receive a confirmation via Email ----------------Volunteer Applicant: Please provide information below by marking X on & (). o I can speak (or write): ()English, ()Mandarin, ()Hakka, ()Taiwanese, ()Other o I have volunteer experience. Please describe below (such as event type or responsibilities). .

Please PRINT clearly your information in all capital letters. You will receive a confirmation via email.

Student Name:(English) Parents Name:(Father) Student Date of Birth : Student School Name : Phone No:(Home) Cell -

(Chinese) (Mother) Gender: F / M Current Grade: (Office) City: State: Zip:

Home address Email: Emergency Contact(person & phone):

Please check all of your volunteer time : ( Please check as many as you can attend ) ShiftS / 7:00~9:00am, ShiftS / 9:00~SS:00am, Shift3 /SS:00~S3:00pm, Shift5 /S5:30~S7:00pm, ShiftS/ S7:00~S9:00pm ShiftS / S3:00~S5:00pm, Waiver of Claims and Liability Release: It is the intent of the undersigned Volunteer and Volunteers parents or legal
guardians to release the Happy Kids Day Organization, its members and each of their respective directors, officers, agents, sponsors, employees, and volunteers collectively from any claims or liability to the fullest extent possible under the law, and to advance that intent the undersigned hereby agrees as follows:
We the undersigned, as a Volunteer and the parents or legal guardians of a Volunteer in the Event, hereby waive and renounce any claims against the Happy Kids Day Organization, its members and each of their respective directors, officers, agents, sponsors, and employees, volunteers collectively, or any other person participating in the Event, including without limitation any claims based on negligence, for any injury to the Volunteer or others, loss damage, sickness, accident, or expenses of any kind whatsoever resulting from the Volunteers participation in the Event.

Happy Kids Day reserves the right to dismiss the volunteer anytime during the event if he/she cannot abide by the event rules.

Students Signature: ______________________________________ Date: _______________________ Parent/Guardians Signature: ______________________________ Date: _______________________

HappyKidsDayVolunteerReg 05/4/11 byCL