City of Independence Volunteer Application

City of Independence Volunteer Application

Thank you for expressing an interest in serving our community through volunteering.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Best time to reach you at this number.

Hour Minutes

AM/PM Option
I acknowledge that volunteers must be able to provide their own transportation and may be required to complete and pass a criminal background check.*

I approve that the City to run a criminal background checkI do not approve the City to run a criminal background check
Birth Date*

MonthDayYear
Date
Driver's License #*
Signature of Volunteer*

Clear
Printed Name*

First NameLast Name
Date*

MonthDayYear
Date
Signature of Parent/Guardian (if under 18 years of age)

Clear
Printed Name

First NameLast Name
Date

MonthDayYear
Date