Volunteer Intake Form

Volunteer Intake Form

Hey team member! Complete or update this form to the best of your ability so we have the most up to date info about you on file. It will take approximately 15 minutes to complete. Thank you!
Personal Information
Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
Residence Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
T-Shirt Size*
Marital Status*
Spouse's Name if Married
Emergency Contact Name*
Emergency Contact Phone Number*
Format: (000) 000-0000.
Basic Role Information
Original Start Date serving with Type Zero*

MonthDayYear
Date
Do you possess a Driver’s License and a good driving record?*
If you answered yes, would you like to be added to the list of team members who are able to transport volunteers during a multi-location event or help provide a ride to a team member that needs it?
We have a zero tolerance policy on expressing inappropriate behavior and hateful speech towards certain groups of people. We define hateful speech as words, written or verbally, that are intended to put down, discriminate, express stereotypes, or hurt a person or group of people. We define inappropriate behavior as behavior, in person or online, such as substance or alcohol use, revealing clothing, and illegal activity. Because we believe all humans are valuable and we are here to do our part to take care of each other, failure to follow this policy WILL lead to immediate dismissal and termination of your role. Do you agree to adhere to this policy?
Select 1-4 Positions You're Interested and Available in Serving this Fiscal Year*

18+yrs: Community Event CoordinatorProviding a service as an expert18+yrs: Social Media/SEO Specialist18+yrs: Family Coordinator (previously known as Welcome Coordinator)18+yrs: youth/parent small group helper/leader18+yrs, annual Volun-tourism Special Vacation: Camp Boggy Creek 3-Day retreat volunteerAll Ages: Dia-Elf Project Team: performer, coordinate surprise home and hospital visits, plan end-of-year holiday partyAll Ages: Community Engagement Team Member: Volunteer tabling events, recruitment, help raise money, etcYouth or Student Volunteer/InternshipAll Ages/Corporate Volunteer: 4-6 Hour community events once every other month (Diabetes Ninja Night, Fun Spot, etc)All Ages, quarterly service: Focus Group where each member has a voice in deciding what we should do next
If you have skills you'd like to provide as an expert, let us know about them and how you'd like to contribute them to Type Zero:
Health Questionnaire
Are you impacted by diabetes?*

Type 1 diabetesType 2 diabetesGestational diabetesParent to a child/adult with diabetesFamily member(s) has diabetesFriend has diabetesSignificant other/spouse has diabetesOther
Please list all other health conditions you have*
We ask this so we can help keep our team safe
Please list any health accessibility and food sensitivity needs you have. If you don't have any, type N/A.*
It's important to us to provide reasonable accommodations for our team members
Do you understand that team members are expected to be working on improving their physical and mental health, and do you feel you are able to participate in community activities that require physical activity, exercise, or challenging emotional conversations?*
Availability
Please select your availability for the given days and time phases*

Monday - MorningsMonday - EveningsTuesday - MorningsTuesday - EveningsWednesday - MorningsWednesday - EveningsThursday - MorningsThursday - EveningsFriday - MorningsFriday - EveningsSaturday - MorningsSaturday - EveningsSunday - MorningsSunday - Evenings
This year, volunteers are required to attend regular Monday or Tuesday night meetings every other week (approximately 7 PM to 8 PM). One of them will be in person and the other will be virtual. Can you meet this requirement? *
Skills and Experience
Please indicate if you have any of the following skills or training

CPR - Cardiopulmonary resuscitationFirst AidOther
Previous Experience that will help you in your role this year – Explain:
References

*If you are ONLY volunteering for a specific 4-6 hour community event, please skip this section.*
All other team members, please list the name of one personal or professional reference
Relationship
Phone Number
Email
Liability Waiver
Today's Date*

MonthDayYear
Date
Volunteer Signature*
Parent/Caregiver Signature (Required for youth volunteer applicants)
Should be Empty:

Volunteer Intake Form

Personal Information

Basic Role Information

Health Questionnaire

Availability

Skills and Experience

References

Liability Waiver