Volunteer Application

Volunteer Application
Which area are you able to volunteer in?
CONTACT INFORMATION
Name

First NameMiddle NameLast Name
Mobile Phone

Area CodePhone Number
Email
example@example.com
Are you 18 years or older?
EMERGENCY CONTACT
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
VOLUNTEER INFORMATION
After we make flower arrangements, we often need help delivering them to local, long-term care facilities. Would you be willing to occasionally deliver flowers using your own vehicle?
Do you have a valid driver's license?
Do you have valid auto insurance for your vehicle?
Have you ever been convicted for violation of any laws, traffic, or otherwise?
I certify that by signing, the information I have provided are true and correct to the best of my knowledge. I understand that any misrepresentation in my application may void my application. I fully authorize any form of background checking or thorough investigation of all matters I have provided here in this application.
Signature
Printed Name

First NameLast Name
Date

MonthDayYear
Date
Should be Empty: