Volunteer Application

Volunteer Application
Contact Information
Title *
Name *

First Name Last Name
DOB *

Month Day Year
Date
Today's Date

Month Day Year
Date
Age
Race
This is optional but we would appreciate your answer as it helps us with funding applications. Your answer will remain confidential.
Are you Hispanic or Latino?

Yes No
Gender
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Cell Phone *

Area Code Phone Number
Home Phone

Area Code Phone Number
Email *
Best Way To Contact You

Email Text Call Home Phone Call Cell Phone
Do you have any special needs?

Consents
I, First Name Last Name, hereby volunteer to participate in the STAIR of Birmingham program (the “Program”). In consideration for my participation in the Program, and the benefits enjoyed by such participation, I agree and acknowledge as follows:
I HAVE READ THE RELEASE, LIABILITY WAIVER AND HOLD HARMLESS STATEMENT, THE EMERGENCY MEDICAL TREATMENT AUTHORIZATION, MEDIA RELEASE, WHISTLEBLOWER POLICY, AND NON-DISCRIMINATION POLICY, FULLY UNDERSTAND THEIR TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS REGISTRATION, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I AM AT LEAST 18 YEARS OLD.
Your Signature

Clear
Parent/Guardian Signature

Clear
If you do not see a submit button here, please go back to the previous page and ensure the appropriate fields are selected for "How many years have you been a STAIR volunteer?" and "Training".
Should be Empty:

Tutoring Information