Youth Volunteer Application-1

Youth Tutoring Volunteer Application

For applicants that are 14 to 17 years old.
Full Name
Date Available

MonthDayYear
Date
Address
Street and City
Phone
Format: (000) 000-0000.
Email
example@example.com
Preferred Method of Contact:
TutoringCheck-in/out & Bathroom EscortSnack set up and clean upProvide snacks
Education
High School
City/State
From
To
Year graduated
Diploma
Parent/Legal Guardian
Name
Relationship
Address
Email
example@example.com
Phone
Format: (000) 000-0000.
References - Please list two unrelated adult references.
Reference #1
Relationship
Years known
Company
Phone
Format: (000) 000-0000.
Reference #2
Relationship
Years known
Company
Phone
Format: (000) 000-0000.
Disclaimer and Signature

I understand that false or misleading information in my application or interview may result in my release from volunteering.

I certify that my answers are true and complete to the best of my knowledge.

If volunteering directly with children, I agree to a formal background check and to complete the Child /Youth Protection Policy training.
Volunteer Signature

Clear
Date

MonthDayYear
Parent/Legal Guardian Signature

Clear
Date

MonthDayYear
Photography and Video Notice

Your and/or your child's participation in this program constitutes your consent for you and your child to be photographed, filmed, and/or otherwise recorded and to the release, publication, exhibition, or reproduction of any and all recorded media of your or your child's appearance, voice, and name for any purpose whatsoever in perpetuity in connection with Mason Community Services, Inc. and its initiatives, including, by way of example only, use on websites, in social media, news and advertising.
Should be Empty: