YVC Waiver Form

YVC Waiver:

Thanks for your interest in joining the Youth Volunteer Corps! Please complete the following form in order to sign-up for projects.
Personal Information:
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Birthdate:

MonthDayYear
Date
Ethnicity

Other
Tee Shirt Size
Gender

Other
School:
Grade:
Name of Adult Caregiver:
Adult Caregiver phone number:
Adult Caregiver Email:
example@example.com
Name of emergency contact if we cannot get a hold of you.

First NameLast Name
Phone Number of emergency contatct

Area CodePhone Number
Any allergies or medical issues we should know about the volunteer?
Does the youth named above meet any of the following criteria? (Check all that apply)
Youth Volunteer Signature
Adult Caregiver Signature
Should be Empty:

YVC Waiver: