Hands On Inland Empire


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	Volunteer with Hands On Inland Empire!

Welcome to the Hands On Inland Empire Member Registration.

Use the form below to register as a volunteer for Hands On Inland Empire projects, courses, and special events.

* denotes a required field

Member Registration Form

First Name *
Last Name *
Date of Birth *
	mm/dd/yyyy
We require date of birth for verification of eligibility with affiliate projects/activities and for demographic reporting for funders.

Mailing Address *
Address Line 1 *
Address Line 2
City *
State *
Zip code *
City

Main Phone Number *		Type*
Other Phone Number		Type

Place of Employment

Your login information will be:

Email Type *

E-mail Address *

Re-Enter E-mail Address*

Password *

Re-Enter Password *

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Click here if you have a disability.

Gender

Education Level

How did you hear about us?

	Internet			Word of mouth
	Your company			Special Event
	Newspaper			United Way - Inland Empire
	Radio			Hands On Network

Terms and Conditions

In connection with my voluntary involvement in activities undertaken for, and with the participation and support of Hands On Inland Empire, a non-profit charitable organization, I hereby agree, for myself, my heirs, assigns, executors, and administrators to release and discharge Hands On Inland Empire, its officers and directors, employees, agents and volunteers from all claims, demands and actions for injuries sustained to my person and/or property as a result of my involvement in such activities, whether or not resulting from negligence, and I agree to release and hold Hands On Inland Empire, its officers and directors, employees, agents and volunteers harmless from any cause or action, claim, or suit arising therewith.  I hereby attest that my attendance and involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the foregoing terms and conditions of this release.  Furthermore, I grant permission for photographs, video and quotations from me during my involvement with Hands On Inland Empire to be used to further promote volunteerism.

I certify under penalty of perjury and in conformance with Education Code section 35021 that I am not required to register as a sex offender pursuant to Penal Code section 290.

I agree I disagree


Untitled Document Hands On Inland Empire (a program of Inland Empire United Way) 9624 Hermosa Avenue, Rancho Cucamonga, CA 91730 909.980.2857 ext 247	AN AFFILIATE OF