Please provide the following information:  

First Name   Team Name
Last Name   Work Phone
    Mobile Phone
Street Address   Home Phone
City      
State   Ethnicity
Zip Code   if other, please add here
     
E-mail      
 

(volunteer instructions will be sent to this address)

T-Shirt Preference?

S M L XL 2XL 3XL

 
       

Special Skills?

Let us know what skills you have and how you can best assist us on the build day! Check any boxes that match either your interests or abilities.

  Professional Amateur Unskilled

Painting/Sanding

Drywall/Plastering
Cleanup/Yardwork
Carpentry
Plumbing
Electrical
Other:

Work Schedule:

Available All Day 8:00 - 5:00
Available Morning 8:00-12:00
Available Afternoon 12:00 - 5:00

Liability & Photo Release

In consideration of the opportunity afforded me to assist on a voluntary basis in the Rebuilding Together of Northwest Arkansas, Inc., ("Rebuilding Together") home repair project, a project in which the homes of disadvantaged persons will be repaired by volunteers, and in light of the aims and purposes of the community service provided by Rebuilding Together in organizing this project, I hereby waive any right or cause of action arising as a result of my participation in said project from which any liability may or could accrue against Rebuilding Together or its officers and directors collectively or individually. Without limiting the generality of the foregoing, I agree that this waiver shall include any rights or causes of action resulting from personal injury to me or damage to my property sustained in connection with my activities for the Home Repair Project. I agree to allow Rebuilding Together to take or have taken, still and moving photographs and film of my involvement with them. I consent & authorize Rebuilding Together and the sponsors to use and reproduce the same in newspapers, films, brochures, television media and wherever it will benefit Rebuilding Together and their sponsors. 

Signature & Acknowledgement Date

 Electronic signature is acceptable and signifies agreement on liability & photo release.