Volunteer Application

Name*

First NameLast Name

Parent Guardian*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Contact #:*

Please enter a valid phone number.

Date of Birth*

Date

Social Security # (last four digits only): *

Grade/Education Level: *

School*

School Counselor (optional):

Do you have a Driver license?*

Driver License/Valid ID # *

Special professional training, skills or hobbies you think will be a help to Knowledge Builders. If no special professional skills, type NA*

Community Affiliations (Clubs, Service Organizations, etc): If no community affiliations, type NA*

Previous/current volunteer experiences (e.g. baseball/softball and years): If no previous/current volunteer experiences, type NA*

Do you have any family in the program?*

If you have family in the program, please list their name

Special Certification (i.e. CPR, Medical, etc.). If you don't have any special certification, type NA.*

Have you ever been convicted of a felony?*

If yes, please expain

Have you ever been convicted of any crime involving or against a minor?*

If yes, please expain

Have you ever pleaded guilty to or been convicted of any other type of crime?*

If yes, please expain

Have you ever refused participation in any otheryouth programs?*

In which of the following would you like to participate?*

Privacy Policy: Please be advised that KBF does not sell or release contact information to any non-affilliated organization. However, KBF and/or its official partners may contact you about special offers and promotions from time to time. However, these partners are not permitted to retain your information for future use unless you specifically grant them permission. You may opt out of these communications at any time by contacting KBF.

Please upload a copy of your government issued ID*

Please list a reference (#1), aside from a family member, at least one of which has knowledge of your particiaption as a volunteer in a youth program. *

Relation to Reference #1*

Phone Number of Reference #1

Please enter a valid phone number.

VOLUNTEER COMMITMENT AGREEMENT: I have read, accept and will adhere to the Volunteer Commitment. I have read and considered the Volunteer Code of Conduct. I understand the policy, and the standards of conduct, and agree to adhere to them. I provide my consent for Knowledge Builders of Florida, Inc. to collect, use and disclose my personal information as outlined in the Privacy Policy. I also agree to my name being listed in the annual report both in print and the online version, as a volunteer. This is to certify that I understand that any information (written, verbal or other form) obtained during the performance of my duties must remain confidential. This includes all information about members, clients, families, employees and other associate organizations, as well as any other information otherwise marked or known to be confidential. I understand that any unauthorized release or carelessness in the handling of this confidential information is considered a breach of the duty to maintain confidentiality. I further understand that any breach of the duty to maintain confidentiality could be grounds for immediate dismissal and/or possible liability in any legal action arising from such breach.

By signing this document you acknowledge that you have received, read and understand the contents of the Volunteer handbook, revised edition 07/27/07. You agree to abide by the policies and procedures set forth in the Handbook and any changes that may occur during the course of your volunteering at Knowledge Builders of Florida, Inc.

I agree to abide by the code: VOLUNTEER CODE OF CONDUCT • Treat everyone fairly within the context of their activity, regardless of gender, ethnic background, color, sexual orientation, religion, political belief or economic status; • Agree to conduct yourself in a manner consistent with the position as a positive role model, and as a representative of Knowledge Builders o Florida, Inc; • Respect the privacy and dignity of participants by not divulging confidential information without consent, except where required by law as in the case of suspected child abuse; • Consistently display high personal standards and project a favorable image of your of volunteering experience. • Refrain from public criticism of fellow members. • Abstain from and discourage the use of drugs, alcohol and tobacco products. • Refrain from the use of profane, insulting, harassing or otherwise offensive language while volunteering. • Regularly seek ways of increasing professional development and self-awareness. • Co-operate with the student’s parents or legal guardians, involving them in their child's development.

You must: • Ensure the safety of the student’s with whom you work. • Respect others' dignity; verbal or physical behaviors that constitute harassment or abuse are unacceptable. • Never advocate or condone the use of drugs or other banned performance enhancing substances. • Never provide students with drugs, alcohol or tobacco products.

Applicant Full Name*

First NameLast Name

Applicant Signature*

Date*

Date

NOTE: Knowledge Builders of Florida, Inc. will not discriminate against any person on the basis of race, creed, color, national origin, marital status, gender, sexual orientation or disability.

Parent/Guardian Signature