Please complete this form to submit a change of address request for your child's Imagination Library books.

Previous Address:

New Address:

Please complete this form to register your child to receive Imagination Library books monthly until his or her fifth birthday. Be sure to complete the Change of Address form if you move.

Mailing Address:

Please complete this form to register for the Day of Service/Day of Caring.

Volunteer Mailing Address:

Workload Capabilities (check all that apply):
Light work (sweeping, reading, sitting, etc.)Medium work (cleaning, painting, moving light objects, organizing, simple landscaping projects, etc.)Heavy work (moving heavier items, construction projects, complex landscaping, etc.)

Parent Consent (if under 18 or still in high school) I recognize that there may be hazards encountered during this work session which are outside the control of the United Way of Perry County and any other nonprofit or religious organizations collaborating herewith and release and agree to hold harmless the United Way of Perry County and these organizations from any liability, claim or complaint arising from those hazards.
YesNo

Photo Release I hereby grant United Way of Perry County permission to use mine or my child’s photograph for purposes relating to the promotion of United Way of Perry County and its programs or events in its publications including newsletters, brochures, annual reports, displays, posters, videography, public service announcements, or any other form of literature or publicity including electronic such as on a website or Facebook. I hereby waive any right that I may have to inspect or approve the finished photo and release the United Way of Perry County from any and all claims, including claims for libel, arising out of the use of the photograph.
YesNo

Please complete this form to report on your funding progress.

Completion of this form does not guarantee that the United Way or any other group will address your project. It is simply a request and a method of organizing requested projects with potential for matching them up with community service or business groups. Please leave complete contact information so you can be reached in the even that your request can be filled. Thank you!

Address:

Please fill out this form in its entirety.

Name:

Address:

Cell Phone (will be used only in case of emergency or inclement weather):

Please identify the types of boards on which you serve (check all that apply):

nonprofit charity or civic organization (United Way, Habitat for Humanity, sorority, Chamber of Commerce, etc.)faith-based organization (K of C, Catholic Charities, Walk to Emmaus, etc.)corporation/businesschurch, synagogue, mosque, etc.