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 Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Residence Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
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
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
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 Coordinator
Providing a service as an expert
18+yrs: Social Media/SEO Specialist
18+yrs: Family Coordinator (previously known as Welcome Coordinator)
18+yrs: youth/parent small group helper/leader
18+yrs, annual Volun-tourism Special Vacation: Camp Boggy Creek 3-Day retreat volunteer
All Ages: Dia-Elf Project Team: performer, coordinate surprise home and hospital visits, plan end-of-year holiday party
All Ages: Community Engagement Team Member: Volunteer tabling events, recruitment, help raise money, etc
Youth or Student Volunteer/Internship
All 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 diabetes
Type 2 diabetes
Gestational diabetes
Parent to a child/adult with diabetes
Family member(s) has diabetes
Friend has diabetes
Significant other/spouse has diabetes
Other
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 - Mornings
Monday - Evenings
Tuesday - Mornings
Tuesday - Evenings
Wednesday - Mornings
Wednesday - Evenings
Thursday - Mornings
Thursday - Evenings
Friday - Mornings
Friday - Evenings
Saturday - Mornings
Saturday - Evenings
Sunday - Mornings
Sunday - 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 resuscitation
First Aid
Other
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
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Volunteer Signature
*
Parent/Caregiver Signature (Required for youth volunteer applicants)
Continue
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