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SPECIAL OLYMPICS
WESTMORELAND COUNTY
VOLUNTEER REGISTRATION FORM
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I am interested in becoming a volunteer with Special Olympics Westmoreland County. I understand that I will be contacted when the events or programs I have indicated below are scheduled but that there is no minimum amount of time required.

Check ALL applicable events:

Alpine Skiing ___	Cross Country Skiing ___	Bowling ___	Cycling ___
Golf ___	Swimming ___	Track and Field ___	Other ___
	Fund Raising ___	Community Events ___

Other Areas of Interest:

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Volunteer Name:	_______________________________________	Age: _____

Street Address:

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City, State, Zip Code:

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Day Telephone #: ____________________	Evening Telephone #:____________________
Email Address: ____________________________

Please read before signing: I understand that:

Upon request, I can be asked to submit an application for a criminal background check.
I will keep confidential any information I may receive during my volunteer activities.
Unless otherwise indicated by me, I grant Special Olympics permission to use my likeness,
voice, and words in television, radio, film, or in any form to promote activities of Special Olympics.

I have read the above and the information I have given is true and complete.

Signed:

___________________________________

Date:

____________

Complete and Mail to:

Special Olympics-Westmoreland County
Volunteer Committee
215 Donohoe Road
Greensburg, PA 15601