VOLUNTEER WITH LOVE

Name *

First Name

Last Name

Phone

(###)

###

####

Location

Jacksonville, FL, or surrounding area

Nashville, TN, or surrounding area

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Areas You'd Like to Serve In

Photography

Event Planning

Logistics/Day of Assistance

Other

I Would Like a WithLove Shirt

($15 Each for Volunteers)

Yes

No

I understand and accept the policy of confidentiality for WithLove, which requires me not to disclose any personal information about our families or their children, which may come to my attention while performing any work on behalf of WithLove.

I Agree

I hereby grant permission to WithLove to reproduce any photos or video shot of (me/my daughter/son) and to use my/his/her name with the photograph.

I Agree

I further consent that the use of my photo/video by include, but is not limited to: the WithLove website, print newsletters, social media, publications, advertising or collateral materials.

I Agree