Name
*
Required for purposes of confidential background check
First Name
Last Name
Text 2
Preferred pronoun
He/Him
She/Her
They/Them
Prefer not to answer
No Pronoun
My Pronoun is not listed
If your pronoun is not listed, please tell us:
Email address
*
Mailing address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Contact phone number
(###)
###
####
Preferred Contact metheod
*
Email
Phone
Other
If Other, please specify:
I'm interested in helping with:
If Other, please specify:
Availability
Check all that apply
If Other, please specify:
Do you need any special accommodations?
What makes you passionate about helping Ebony Road Players?
How did you hear about volunteering with Ebony Road Players?
I am fluent in the following languages.
*
Fluent is defined as able to speak or write a particular language easily and accurately.
If Other, please specify:
Consent to background check
*
I hereby authorize Ebony Road Players (ERP) bearing a copy of this release, at anytime during my participation as a volunteer to run a background check. ERP may obtain any information pertaining to my criminal history from local, state or federal agencies as necessary to ensure the safety of ERP, it's staff or others in the community. This release is executed with the full knowledge and understanding that the information is for the official use of ERP. Consent is granted for ERP to furnish such information, as directed above to third parties in the course of fulfilling its official responsibilities. I hereby release ERP and any agencies needed to obtain this information from any and all liability for damages of whatever kind, which may at the time result to me, my heirs, family or associates because of my compliance with this authorization and request to release information, or any attempt to comply with it.
Consent to media release
*
I acknowledge that my participation is completely voluntary. I understand that by participating in volunteer activities with Ebony Road Players (ERP) I may be recorded on video and/or audio tape and such recordings may be broadcast on television, radio, or via the internet, and I give my consent. I understand that by participating I may be photographed or quoted and that such photos or quotations may be published in a newspaper, a magazine, a publication of the ERP, or on the internet, and I give my consent. I agree to release ERP staff, agents, contractors, and programs from any liability associated with the broadcast of video or audio tape recordings or publication of photographs of my participation in volunteer activities for ERP.
I certify that the above information is true and correct.
*
I would like to join your mailing list.
Additional comments
Anything else you would like to add.
