City of Independence Volunteer Application

City of Independence Volunteer Application

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

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / 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 check I do not approve the City to run a criminal background check
Birth Date *

Month Day Year
Date
Driver's License # *
Signature of Volunteer *

Clear
Printed Name *

First Name Last Name
Date *

Month Day Year
Date
Signature of Parent/Guardian (if under 18 years of age)

Clear
Printed Name

First Name Last Name
Date

Month Day Year
Date

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