Volunteer Recruitment Form

Parent Wellness Advocate (Home-Based) Volunteer Registration

The Fill in the form below to volunteer to our organization
Name*

First NameLast Name
Former Names

First NameLast Name
Which time of day are you able commit to?*

Mornings (8 am - 12pm)Afternoons (12 pm - 4 pm)Evenings (4 pm - 8:30 pm)
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Phone Number*
Which days of the week are you able commit to?*

MondaysTuesdaysWednesdayThursdaysFridaysSaturdaysSundays
How many hours are you available weekly?*
When can you start?*

MonthDayYear
Date
References

Please provide 2 reliable professional or personal references
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relationship*
Years Known*
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relationship*
Years Known*
All volunteers must successfully pass an internal screening and background check. Do you consent to this requirement?*

YesNo
As a Parent Wellness Advocate Volunteer I acknowledge there is:
- No caregiving or babysitting (Clients will be referred to our respite partner)
- No being alone with children
- No restroom or personal care
- No discipline
- No providing transportation
- No keeping "secrets"
I agree to these rules.
Checkbox acknowledgements for:
- No violent/sexual/abuse convictions
- No CPS/APS involvement
- No restraining orders
- No current investigations
- Agreement to disclose changes
I understand false statements may result in removal.
ID Verification Attestation*

I attest under penalty of perjury that I am 18 years of age or older and possess a valid government-issued photo ID. I understand that I may be asked to present this ID for live visual verification prior to placement with a family or participation in program activities.
Signature*

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Parent Wellness Advocate (Home-Based) Volunteer Registration

References