Office Volunteer Registration Form

Office Volunteer Registration Form

Please complete the form. Some sections are for reporting purposes only and are identified as such.
Literacy Council of Fort Bend County

AN AFFILIATE OF PRO LITERACY AMERICA
Source of Referral*
First Name*
Middle Name
Last Name*
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemaleOther
Address*
City, State and Zip*
Country of Birth*
Home Phone*
Please enter a valid phone number.
Okay to call the home phone?*

Yes, mornings onlyYes, afternoons onlyYes, evenings onlyNo, emergencies only
Cell Phone*
Please enter a valid phone number.
Okay to call the cell phone?*

Yes, mornings onlyYes, afternoons onlyYes, evenings onlyYes, text before callingNo, text onlyNo, emergencies only
Email address
example@example.com
Emergency Contact's First and Last Name*
Emergency Contact's Phone*
Relationship*
Languages Spoken*
Please list all proficiencies other than English
(Optional: For Reporting Purposes Only)
For Reporting Purposes Only

Please select all that are relevant to you
Ethnicity

Hispanic or LatinoNot Hispanic or Latino
Race (select one or more)

American Indian or Alaska NativeAsianBlack/African AmericanNative Hawaiian or other Pacific IslanderWhitePrefer not to respond
Employment Status
Does your employer offer a matching-gifts program?

YesNoUnsureN/A
CONFIDENTIALITY AGREEMENT
This agreement applies to all volunteers associated with and/or involved in the activities or affairs of The Literacy Volunteers of Fort Bend County, Inc. d/b/a The Literacy Council of Fort Bend County (LCFBC This includes all activity associated with LCFBC at its main office and all outreach site locations.

All data, materials, knowledge and information generated through, originating from, or having to do with LCFBC or persons associated with our activities, is to be considered privileged and confidential and is not to be disclosed to any third party.

Client information, including all file information, is not be disclosed to any third party, under any circumstances, without the consent of the LCFBC Executive Director.

My signature signifies I agree to these terms and will abide by, adhere to and honor all of the above.
Signature of Volunteer*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty:

Office Volunteer Registration Form

For Reporting Purposes Only

CONFIDENTIALITY AGREEMENT