FOR OFFICE USE ONLY
Entered by:
Date entered:
08-09-2023
Today’s Date:
VOLUNTEER APPLICATION FORM
1. Personal Information (PLEASE PRINT)
Last Name: First Name: Middle Initial:
Address: City: State: Zip Code:
Mobile Phone: ( ) - Home Phone: ( ) - Email:
Emergency Contact: Emergency Phone: ( ) -
Do you speak another language? Yes No Please specify:
2. Please list any sports you play or coach:
3. Please list any health or leadership topics you are interested in:
4. Please list your previous experience with youth:
5. Please mark your weekly availability with an ‘X’ in the box of a time in which you are available:
Monday Tuedsay Wednesday Thursday Friday
9:00 am
10:00 am
11:00 am
1:00 pm
2:00 pm
6. Please mark volunteer roles you are interested in:
Taking attendance and passing out name tags
Demonstrating activities
Co-leading activities with the staff
Assisting with administrative tasks
Taking pictures for marketing purposes
Leading transition game
Other
7. Do you have access to a car?
Yes
No
8. Equal Opportunity Monitoring - Please select (optional)
Gender: Female Male
Race/Ethnicity: Caucasian
Latino
African-American
Native-American
Asian
Other
Date of Birth:
In connection with my voluntary involvement in activities undertaken for, and with the participation and support of a non-profit
organization, I hereby agree, by signing this document, for myself, my heirs, assigns, representatives, executors and administra-
tors to release and discharge officers and directors, employees, agents, volunteers, heirs, assigns and representatives, to the
fullest extent permitted by law, from all claims, demands and actions for injuries sustained to my person and/or property as a
result of my involvement in such activities, or losses or damages of any kind, whether or not resulting from negligence and I
agree by signing this document to release and hold officers and directors, employees, agents, volunteers, heirs, assigns and
representatives harmless from any cause or action, claim or suit arising therefrom. I hereby attest by signing this document that
my attendance and involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the
foregoing terms and conditions of this release. I grant full permission for organizers to use photographs and video of me and
quotations by me in legitimate accounts and promotions of these activities.
08/17/2023
Signature: Date:
