Group volunteer opportunity details:

Preferred Dates and Times *
Budget *
Number of Volunteers *
Age Range of Volunteers *
Group Type *
Group Name *
One time event or ongoing? *
Which group opportunities seem like the best fit for your group? *
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Team Leader personal information:

First Name *
Last Name *
Email *
Email Type *
Primary Phone
Phone Type
Date of Birth *
Home Address *
Home City *
Home State/Province *
Home Zip/Postal Code *

Church (if applicable)
Volunteer Organization
Current Employer
Current Profession
Already connected to staff? Tell us who
How did you hear about Breakthrough? *

I already volunteer in this area
Additional Area of Interest
 Yes, I'd like to recieve periodic updates from Breakthrough

I give Breakthrough permission to use any video or photography taken of me during my volunteer experience for their marketing materials such as (but not limited to) newsletters, publications, brochures, videos and website.

I desire to participate in various programs, events, activities or service projects (each, an “Activity” or “Activities”) sponsored, organized or operated, at least in part, by Breakthrough Urban Ministries, Chicago, Illinois (“BTUM”), and I understand and acknowledge that BTUM will not allow me to participate in the Activities unless I first release and hold harmless BTUM, its directors, employees, or other agents (collectively, “Agents”) from and against any damage and liability relating to or arising out of my participation in the Activities. I understand and acknowledge that my participation in an Activity exposes me to various risks, and I have considered these risks and possible dangers involved.

THEREFORE, in consideration of the permission extended to me by BTUM through its Agents to participate in an Activity, I, for myself and for my heirs, legal guardians or representatives, successors and assigns (collectively, “Representatives”), agree to UNCONDITIONALLY RELEASE AND FOREVER DISCHARGE BTUM and its Agents from any and all claims, demands, and causes of action of whatsoever nature, which I or my Representatives ever may have against any of them on account of or related to such Activities or my participation therein. I hereby assume any and all risks associated with my participation in and related to such Activity, and I unconditionally agree to hold BTUM and its Agents blameless for any liability concerning my personal health and well-being, or any injuries incurred while participating in an Activity.

I have carefully read the foregoing, and I understand that my signature constitutes a full and complete release of BTUM and its agents and an agreement to hold such parties harmless from any liability for all injuries incurred while participating in an Activity.
 I have read and agree to comply with the above Media and Liability Release