ELC Volunteer Registration Form

Instructors are Life Skill Coaches who instruct clients on practical skills or topics from the instructors’ area of experience or expertise.

Some examples of life skills include: cooking, baking, basic car maintenance, hair braiding, sewing, interviewing skills, ASL, using public transportation, crochet, banking, house keeping, musical skills, and social interactions.

All life skill sessions will be scheduled with coordination from the Client Advocate. If the life skill requires multiple days (such as musical skills or gardening) set days and times can be coordinated in advance.

When registering to share a skill, please include any materials, ingredients, or equipment that would be needed at least a week prior to your scheduled session. Please note scheduled sessions may require some flexibility based on the flow of the day. Life skill sessions are typically about 1 hour.

Full Name*

First NameLast Name

Please select your current age range*

Over 18 under 21Over 21 under 35Over 35

E-mail*

example@example.com

Phone Number*

Can this number receive texts?*

YesNo

Please list the life skills you would like to share?*

Different skills can be done over multiple days or on a weekly basis

Would your skill require 1 day or more than 1 day*

YesNo

What day(s) would you be available?*

TuesdaysWednesdaysThursdays

What equipment would be needed for your lesson?*

Would safety equipment be needed for your lesson?*

YesNo

Please list needed safety equipment

example, oven mitts, goggles

Please list a non family member reference*

First and Last nameRelation

Reference phone number*

Please enter a valid phone number.

Years known*

Have you ever had any non motor vehicle arrest or convictions*

YesNo

if yes list offense and year of conviction / arrest

Do you have any current or pending criminal charges? Are you currently on probation*

YesNo

if yes list offense and year of conviction / arrest

if on probation list name and contact number of probation officer

Have you ever been let go, fired or asked to leave a position, working with children, youth, elderly or other vulnerable persons/ populations?*

YesNo

If yes, please explain. Include dates and details of dismissal

Have you ever had an accusation of inappropriate or violent conduct made against you*

YesNo

If yes, explain. Include date, details and outcome of accusation. i.e. were criminal or civil charges filed or was the accusation dismissed

Have you ever been instructed not to have contact with children or do you have a history of sex offender registration?*

NoYes

To the best of my knowledge the above information is true and accurate. *

Comments

Instructor - Life Skill Coach Registration Form