FORESIGHT ADVENTURE GUIDES FOR THE BLIND
RETURNING VOLUNTEER APPLICATION - THIS APPLICATION IS FOR ALL RETURNING VOLUNTEERS
Personal Information:
Full Name:
First Name
Last Name
Date of Birth:
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Month
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Day
Year
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Current Mailing Address:
Street Address
Endereço (cont.)
City
State/Province
Postal/Zip Code
Telephone:
Format: (000) 000-0000.
Email:
Example@example.com
Emergency Contact Name:
First Name
Last Name
Emergency Contact Phone#:
Format: (000) 000-0000.
Emergency contact relationship:
Occupation:
Employer Phone #:
Format: (000) 000-0000.
Present Employer:
What was the last season you were a volunteer at Foresight?
How many years have you been with us?
Are you a veteran of the US military?
Yes
No
Branch of Service
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Do you have personal medical insurance?
Yes
No
A copy of your health insurance card is required.
May we put your name, email address and phone number on a list available to all Foresight volunteers?
Yes
No
Winter Only - Will you have a season's pass for the upcoming ski season?
Yes
No
If yes, which type?
Summer Only: Do you have experience with any of the following activities? (check all that apply)
Stand Up Paddle Boarding/Kayaking/Canoeing
Rock Climbing
Hiking
Archery
Fly Fishing
Rafting
Aerial Ropes Courses
Please indicate if you have had experience working with people with any of the following disabilities: (check all that apply)
Blind/Visual Impairment
Cerebral Palsy
Spina Bifida
Developmental Disability
Spinal Cord Injury
Post Polio
Deaf/Hearing Impairment
Amputation
Brain Injury
Autism
Other
If you are PSIA/AASI, ACA, or certified by any other officially recognized body, please list type & level of certification:
Do you have any current medical certifications:
CPR
Basic First Aid
Other
Have you been convicted of a felony (excluding any record or conviction that has been judicially sealed, expunged, eradicated or dismissed)?
Yes
No
If yes, please explain (a conviction will not necessarily disqualify your application):
Have you ever been charged with child neglect or abuse?
Yes
No
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If yes, please explain:
Has your drivers' license ever been suspended or revoked?
Yes
No
If yes, please explain:
Are there any facts or circumstances involving you or your background that would call into question your being entrusted with the supervision, guidance or care of youth or disabled individuals?
Yes
No
If yes, please explain:
Certification and Acknowledgement
I certify that all information submitted in this application form, or any resume, interview or other information, is true and complete and that I have not knowingly withheld, or will I withhold, any information that would affect my volunteer application. I understand that Foresight Ski Guides is under no obligation to consider or reconsider this application at any time, and that acceptance of my application does not constitute an offer of employment or volunteer status. I also understand and agree that:
1. Inquiries may be made of my employer, previous employers or others who may have knowledge of me, or with investigative, or other private or governmental agencies that may have information concerning me and release all parties from any and all liability, claims or damages it made directly or indirectly from providing that information. I also agree to hold harmless Foresight Ski Guides, the officers, directors, employees and volunteers thereof.
2. I understand that if my application to participate as a volunteer at Foresight Ski Guides is accepted, my status as a volunteer may be terminated with or without cause or notice at my option or at the option of Foresight Ski Guides.
3. I understand that in signing this application, I affirm that the information I have given is true and correct.
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Month
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Day
Year
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Signature
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