VOLUNTEER ENROLLMENT FORM

VOLUNTEER ENROLLMENT FORM
Name: (Last, First, MI)
Today's Date:
Birth Date
Age:
Address:
City:
State:
Zip:
County:
Phone (Home):
Phone (Cell):
Email:
How did you hear about RSVP?
What kind of volunteer work are you interested in? Are there specific interest or skills would you like to share as a volunteer?
Are you currently Volunteering?

YesNo
If yes, please list agency (ies) name and job duties:
Current/Past Occupation (s):
Current/past employer (s):
Are you a military veteran?

YesNoMy spouse is a veteranI am a window/er of a veteranI have a service member in my family
In the event of an emergency, please contact:
Name:
Relationship:
Address:
Phone (Day):
Phone (Evening):
Because all RSVP Volunteers recieve free supplemental insurance and the option of reimbursement for travel, the following information is requested.
Please list your benficiary for RSVP's free Accident Insurance:
Name:
Relationship:
Address:
Phone (H):
Phone (W):
How do you plan to travel to your volunteer opportunity? (Please Check)

DriveWork in HomeBus/Metro MobilityWalk
Please complete the following if you plan to drive:
Driver's License No.:
Insurance Company:
Policy Number:
I agree that if I use my personal automobile to travel to and from my volunteer workstation, I will arrange to keep in effect: automobile liability insurance equal to the minimum required by the State of Minnesota.
Please Initial & Date:
I authorize Volunteers of America MN/WI (VOA MN/WI) and its affiliates to use and publish photographs or other likeness of me, my name, and descriptions of my service as a volunteer for whatever purpose VOA MN/WI deems appropriate. I hereby do waive any claims that I may have which may arise at any time in connections with the authorization given or the use or publication of such photographs or other likeness of me, my name, give up all rights to receive payment, do not limit on the period of time in which the photographs or videos may be used, and descriptions of my service by VOA MN/WI or its affiliates, I hereby release VOA MN/WI and its present and past officers, directors, managers, employees, agents, and affiliates, from all such claims and any and all related injury and damage
Please Initial and Date:
I confirm that the information on this form is true and complete to the best of my knowledge.
Signature: (Please sign with Mouse or on a touch screen using your finger)

Clear
Sex:
Race/Ethnic Group:

Asian or Pacific IslanderAfrican AmericanCaucasian (white)HispanicNative AmericanOtherOther
Should be Empty: