Your Name (required)

Email Address (required)

Mailing Address

Phone Number

What kind of program best meets your needs? (check all applicable)
Workshops/SessionsSpecial NeedsFundraising/'Friend' raisingInternships

Do you want to be included on our mailing list for public events and workshops?
YesNo

Do you have prior experience with the special needs community?
YesNo

Preferred day & time to get involved:
Weekdays DaytimeWeekdays EveningsWeekendsHolidays/VacationsSpecial Events Only

What goals do you have for your experience?
We want to best match your skills & interests with our programs. Please be specific:

Have you ever been charged with a felony?
YesNo
If Yes, please explain:

Are you physically able to assist in our workshops?
YesNo
If No, please explain:

Do you have any special concerns?

Consent and Agreement - For the opportunity to participate in a Life is Washable® workshop or any other event connected with Life Is Washable, Inc. and for other valuable consideration, I understand that by signing this release, I agree to hold harmless Life Is Washable, Inc, including all of its employees, managers, directors, volunteers and agents; all sponsoring organizations and any other parties connected with events and activities, singly or collectively, from any liability for any injury, harm, loss, inconvenience or damage suffered or sustained as a result of participation in one or more events or any activities associated therewith. I understand that I will be working with volunteers from the community to create artwork which may be used to raise funds for Life Is Washable, Inc. or its affiliates. I understand that all artwork will become the property of Life Is Washable, Inc. I waive all claims for any compensation from the sale of artwork. I hereby give my permission to Life Is Washable, Inc. to use my photograph or portion thereof, whether still or moving, my voice, and my likeness for trade, for publicity or for any other lawful manner whatsoever, hereby waiving my right to review or approve such photograph, sound recording or likeness prior to its use. I understand that all trademarks on or in association with the services covered by the registration for MAGIC PAINTBRUSH PROJECT® and to use the subject matter of pending U.S. patent application serial no. 61-062,224 are protected by intellectual property law. I have read and understood the consent form.

I have read and agree to the terms