ROADRUNNER FOOD DISTRIBUTION VOLUNTEER REGISTRATION FORM DISTRIBUTIONS OCCUR THE 2ND FRIDAY OF EVERY MONTH To view our Volunteer Requirements and COVID-19 Safe Practices, click HERE. Thank you for volunteering to assist with our Monthly Food Distribution. It is because of community members like you that we are able to continue helping our communities most vulnerable. If you need to cancel the day of the distribution, please text Linda at 505-947-8898. Will you be assisting in Artesia or Carlsbad? * - Select -ArtesiaCarlsbad First Name * Last Name * Organization Representing (If not representing an organization, type N/A in the field) Phone Number * Email Address * Emergency Contact * Emergency Contact Phone Number * Do you have any medical conditions we need to know about? (If none, please type NONE in the space provided. This will help us distribute volunteer duties. There is a job for almost everyone.) * Are you able to lift 40 pounds safely? (This will help us with volunteer placement.) * - Select -YESNO VOLUNTEER WAIVER All United Way of Eddy County volunteers must consent to this release form prior to participating in any United Way of Eddy County volunteer activity. LIABILITY WAIVER: In consideration of the opportunity to volunteer, I hereby agree to waive all rights to pursue any claims, lawsuits or legal actions of any type against United Way of Eddy County and/or its officers, employees, agents, board members, volunteers, event sponsors and all other persons working with respect to this activity including Epworth United Methodist Church. I expressly release and discharge said parties from any and all responsibility and liability for injuries, harm, losses or damages of any type to my person or property that I may sustain while participating in any manner in United Way volunteer activities no matter the location in which said activity takes place. Even if such injuries harm, losses or damages are caused, in whole or in part, by its employees, officers, board members, volunteers, event sponsors and all other persons working with United Way or Epworth United Methodist Church. I will notify the project coordinator at my project site if I have any physical limitations that would affect my ability to participate in said volunteer activity. By signing below, I state further that I have read the above release, prior to its execution, that I am fully familiar with the contents thereof, and that I am in full agreement to its terms. PHOTO/VIDEO RELEASE I hereby assign the rights to interview transcripts, video recordings and/or photographic recordings made of me by United Way or its agency/agencies to United Way. I hereby authorize the editing, duplication, reproduction, copyright, exhibition, broadcast and/or nonprofit use and distribution of said transcripts, recordings and/or photographs for purposes deemed suitable by United Way. Such promotion includes, but is not limited to, publication of said transcripts, recordings and/or photographs in newspapers, newsletters, billboards, television, radio, vehicle, brochures, emails, websites and other forms of promotion. I understand that by my signature, I also waive all rights to compensation for the use of all said materials. I hereby waive any right to approve the finished products. My image and statements referring to me may be used with or without identifying me. This waiver is in effect for one year of signing. I have read the volunteer requirement and I consent to the waiver * - Select -YESNO T-Shirt Size (Only complete if a United Way T-Shirt is needed. You are welcome to use a T-Shirt representing your organization) - None -Adult SmallAdult MediumAdult LargeAdult XLAdult XXL CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.