Volunteer Application Form for Non-Profit

The Mix is a nonprofit youth development center where our mission is to inspire our youth to thrive and empower the families in our community. You giving your time, talent, and treasure helps us to continue our mission and continue our legacy in Lancaster City.

The information provided through this form will help us determine the best volunteer opportunity for you and help to better serve our students. Please reach out to office@themixlancaster.org if you have any questions.

Name

Prefix First Name Last Name

Birth Date

Month Day Year

Email

example@example.com

Phone Number

Area Code Phone Number

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Why are you interested in volunteering at The Mix?

Are you volunteering to fulfill an academic requirement? If yes, please explain.

Please list any previous experience you have working with youth including the organization's name, your role, and the age group.

Please choose the activities you are most interested in or participate in.

We require the following background checks:

PA Child Abuse History

PA State Police Criminal Record Check

FBI Fingerprint Clearance

Please send copies of your background checks to the Administrative Coordinator at glopez@themixlancaster.org. An instruction sheet can be found on our website www.themixlancaster.org.

Select your available days

From

: Hour Minutes AM/PM Option

To

: Hour Minutes AM/PM Option

IF YOU ARE UNDER 18 YEARS OF AGE, PLEASE HAVE YOUR PARENT/GUARDIAN COMPLETE THIS PORTION FOR YOU TO VOLUNTEER AT THE MIX.

I, First Name Last Name, parent/guardian of First Name Last Name, agree to allow him/her to volunteer at The Mix. I have read and understand all the volunteer information provided. I will be responsible for the transportation of my teen to and from The Mix and any events pertaining to his/her volunteering responsibilities.
Signature Date

DISCLOSURE

I verify that all the information on this application is true, complete, and accurate. I understand that if not, I will disqualify myself from becoming a volunteer at The Mix. I understand that this is a volunteer position, and that this application is not for employment or contract of employment at The Mix. As a volunteer at The Mix, I will not accept payment for my services and agree that I will be responsible for transportation and cost of transportation to and from The Mix. I give The Mix permission to utilize any photos or videos of me. I agree that I will obtain the necessary background checks and clearances as stated by the law of Pennsylvania to work with children. I understand that I will not be permitted to volunteer until The Mix has received all the necessary background checks and clearances.

Date

Signature