Volunteer Application

Name *

First NameLast Name

Date of Birth*

Date

Email*

example@example.com

Phone *

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone*

Area CodePhone Number

How did you hear about Jane Doe No More?*

Name of company/sponsor*

Name of friend/family member*

First NameLast Name

Race/Ethnicity

Specify races*

Gender: How do you identify?

FemaleMaleNon-binaryPrefer to self-describe

Self-describe*

Sexual Orientation

How do you envision your role in the organization?*

Previous Work or Volunteer Experience*

Skill Set*

ie. Written and verbal communication, event planning, time management, leadership etc.

Education and/or Life Experience*

Name of 1st Reference*

First NameLast Name

Name of 2nd Reference*

First NameLast Name

Phone for 1st Reference*

Please enter a valid phone number.

Phone for 2nd Reference*

Please enter a valid phone number.

Email for 1st Reference*

example@example.com

Email for 2nd Reference*

example@example.com

Days & Hours of Availability

Photo/Media Release
I hereby expressly agree, without any right to inspect or approve finished product or use of images, to permit:

1. The taking, use, reuse, publishing and republishing of photographic, including audio and or video recordings and images of me including images, videos or recordings in which my image or voice may be included in whole or in part, or composite or distorted in character or form without restriction as to changes or alterations (editing) from time to time, in conjunction with my name, or fictitious name, or reproductions of such photographs or audio or video recordings made through any medium, and displayed by Jane Doe No More and East Coast Training Systems in any and all media nor or hereafter known, including the internet, for educational, advertising, fundraising or any other lawful purpose;

2. The use of any published content/matter, including statements from you made in conjunction with such photographs, or video or audio recordings; and

3. The digital compositing, or distortion of the images or recordings, including without limitation any changes or alterations as to color, size, shape, perspective, context, sound quality, clarity or content, foreground or background; all in the furtherance of the mission of the Jane Doe No More, Inc. (including advocacy or lobbying).

I hereby expressly assume responsibility for and fully release and hold harmless, Jane Doe No More, its officers, employees, volunteers and agents, including any photographer, videographer, web editor, engaged by any of them, from and against any claims for damage or loss relating to any of the foregoing."

This is to certify that I,First Name* Last Name* , am at least 18 years old and have read, understand and agree to the above terms.

Signature*