Volunteer Application

Before completing this application please read the Volunteer Policies, Non-Disclosure Agreement, Waiver and Publicity Release and Code of Conduct

Name:*

First

Last

Address:*

Street Address City State / Province / Region Postal / Zip Code

Your volunteer confirmation will be sent to you via email. Please enter a VALID email address.

E-mail:*

Phone:*

Area Code

Phone Number

Emergency Contact:*

First

Last

Emergency Contact Phone:*

Area Code

Phone Number

Tell us about yourself and your experience:*

Several opportunities require the ability to lift 25-50 lbs., bend, reach and may require extended periods of time on your feet. Accomodations are available.:*

Yes, I can lift 20-50 lbs.

No, I cannot lift 20-50 lbs.

Have you ever been convicted of a crime other than a minor traffic violation?:*

Yes

Are you requesting service hours for the charge?

Yes

If yes, charge:

Date Convicted:

Location:

Ordered/Mandatory Community Service by (Agency/Court):

Number of Hours Required:

Monday Start:

AM/PM

Monday End:

AM/PM

Tuesday Start:

AM/PM

Tuesday End:

AM/PM

Wednesday Start:

AM/PM

Wednesday End:

AM/PM

Thursday Start:

AM/PM

Thursday End:

AM/PM

Friday Start:

AM/PM

Friday End:

AM/PM

Volunteer Policies: PLEASE ENTER YOUR INITIALS*

Non-Disclosure Agreement: PLEASE ENTER YOUR INITIALS*

Waiver/Publicity Release: PLEASE ENTER YOUR INITIALS*

Code of Conduct: PLEASE ENTER YOUR INITIALS*

Signature (Please enter your First and Last Name):*

If you would like a copy of your application for your records, please click the printer before you submit your application. You will receive an email confirmation as well.

Volunteer Application

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