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.Format: (000) 000-0000.
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.
Birth Date

MonthDayYear
Date
Driver's License #
Signature of Volunteer
Printed Name

First NameLast Name
Date

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

First NameLast Name
Date

MonthDayYear
Date