Date: ______________________ DOB: _________________ Younger than 18? First Time Volunteer? Name: _____________________________________________________________________________________ Address: _____________________________________________________________ Apt #: ________________ City: __________________________________________ State: ___________ Zip Code: _________________ Home Phone: __________________________________ Cell Phone: __________________________________ E-mail: ____________________________________________________________________________________ Church/Organization affiliation (if applicable): ______________________________________________________

(Please print very clearly and submit prior to volunteering) 800.736.2773 www.dontwalkby.org volunteer@newyorkcityrelief.org

VOLUNTEER APPLICATION

DRESS CODE POLICY: It is important to dress modestly and wear appropriate clothing. DO NOT wear open-toed shoes, short shorts, bare midriffs, tight clothing, tank tops, clothing with vulgar or explicit messages, clothes advertising drugs/alcohol or wear expensive clothes or jewelry. We will be serving outside so please prepare for the weather conditions when you serve. NO FRATERNIZATION POLICY: For your safety, the Rescue Alliance NYC maintains a no-fraternization policy. DO NOT fraternize, flirt with, or give any personal information to any staff, volunteers, community service workers, or others encountered during your time with or after your time with the Rescue Alliance NYC. ANY contact with ANY person MUST be approved of by an outreach staff leader. If you give your personal information to any individual such as phone number, email address, mailing address, etc. you may be opening yourself up to unwanted contact.

RELEASE: I hereby grant the Rescue Alliance NYC, the full right to use my participation in the Dont Walk By outreach in part or in full in audio, video, published and/or produced in any form, in any way that the Rescue Alliance NYC deems useful. I agree to adhere to all Rescue Alliance NYC policies and I further release the Rescue Alliance NYC, from responsibility of any harm or sickness incurred as a result of volunteering at Dont Walk By. SIGNATURE:_______________________________________ DATE: ______________________ PRINT NAME: ____________________________________________ IF YOU ARE UNDER THE AGE OF 18 YOU MUST HAVE A PARENT OR LEGAL GUARDIAN SIGN AND AGREE TO THE ABOVE RELEASE FORM. THANK YOU. PARENT/GUARDIAN SIGNATURE:_____________________________________ DATE: ____________ PRINT NAME: ______________________________________ PHONE: __________________________

How did you hear about this outreach? Annual February DWB outreach New York City Relief Rescue Alliance Other: _______________________________