EmailMe Form - Brain Tumour Walk Volunteer Form

Have you ever volunteered with us before?

Yes

No

Please select event:

Only cities with volunteer opportunities will be listed

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Phone *

### - ### - ####

Year of Birth

Emergency Contact *

First Last

Emergency Contact Phone *

### - ### - ####

How did you hear about the Brain Tumour Walk volunteer opportunity?

Why are you interested in volunteering with the Brain Tumour Foundation of Canada walk events? *

Preferred Role (please check all that apply)

Are you a (please select one)?

Patient/Survivor

Caregiver

Healthcare Professional

Family Member/Friend

If you are a Patient/Survivor, what is your tumour type?

Release and Indemnity

In signing this release and indemnity, I confirm I fully understand the intent of this release and indemnity, and I hereby release, indemnify and agree to hold harmless Brain Tumour Foundation of Canada, and its corporate sponsors, cooperating organizations and any other parties connected with this event in any way from and against any costs, suits, liability from any injury, harm, loss or damage suffered or sustained as a result of participating in the Brain Tumour Walk or any activities associated therewith. I hereby consent to and permit any emergency medical treatment in the event of injury or illness. I also give full permission for the use of my name, photo(s) or any video footage of myself with this event.

Electronic Signature *

Date signed *

MM / DD / YYYY

Disclaimer *

I confirm I'm 18 years of age or over

If you are under 18, please have a parent or guardian sign