YBL: Individual Volunteer Form

Individual: Volunteer Sign up Form

Thank you for your interest in YouthBuild Louisville! Completing this form in its entirety, will enable us to see where you might best help our program and what activities would be most fulfilling to you. Please take your time and answer the questions thoroughly. You will be contacted by our Outreach Coordinator when we receive your information.
YouthBuild Louisville is an equal opportunity organization and will not allow discrimination based upon age, ethnicity, ancestry, gender, national origin, disability, race, size, religion, sexual orientation, socioeconomic background, or any other status prohibited by applicable law.

If reasonable accommodation is needed, please contact us at 502-290-6121. YouthBuild Louisville is committed to the full inclusion of all qualified individuals. As part of this commitment, YouthBuild Louisville will ensure that persons with disabilities are provided reasonable accommodations.
Personal Information
Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Date of Birth*

MonthDayYear
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
If volunteering with a group, please give group name:
School (If currently enrolled)
Employer (If currently employed)
Have you ever been convicted of a sex crime or as a violent offender? (Per KRS 17.165: A positive response prohibits you from volunteering at YouthBuild Louisville. )*
Emergency Contact / Medical Information
The volunteer coordinator will use this information to assess the best volunteer opportunities on an individual basis. Your information is considered personal and confidential and will only be used to customize your volunteer experience; or in emergency situations.
Emergency Contact:*

First NameLast Name
Relationship*
Contact Number*

Area CodePhone Number
Taking any medications?*

YesNo
If "YES", please list:
Do you have any physical limitations or medical conditions that might prevent you from safely doing certain tasks?*

YesNo
If yes, please describe the limitations:
In emergencies requiring immediate medical attention, you will be taken to the nearest hospital emergency room. Your "check" in the box below authorizes YouthBuild Louisville to have you transported to that hospital.
Emergency Authorization:*

I understand and consent to the above statement.
Releases
Confidentiality Agreement: YouthBuild Louisville insists that its volunteers adhere to a strict code of confidentiality. Volunteers may become aware of confidential information about specific students, which may include such information as students’ academic performance, behavior, health, disabilities and related matters. I understand and agree that I will not disclose such confidential information except to YouthBuild Louisville staff. I understand that any breach of these confidentiality requirements may result in my immediate termination as a volunteer and may result in legal action against me.
Confidentiality Agreement:*

I understand and consent to the above statement.
Background Check: All Volunteers are subject to a criminal background check (CBC) including a sex offender registry check (SRC). The information provided on the Volunteer Application will be used to conduct the background checks. I understand that the background check I am authorizing will be conducted solely for the purpose of protecting and preventing any harm to any member of the YouthBuild Louisville program. Information obtained in this check will be treated as confidential.
Background Check: *

I understand and consent to the above statement.
Media Release: I hereby consent to the participation in interviews, the use of quotes, the taking of photographs and videos, or other types of media productions that capture my name, voice, and/or image. I also grant to the right to edit, use, and reuse said products for nonprofit purposes including use in print, on the internet, and all other legal forms of media. I hereby release YouthBuild Louisville and employees from all claims, demands, and liabilities whatsoever in connection with the above and waive any rights to royalties or other compensation arising or related to the use of such materials.
Media Release:*

I understand and consent to the above statement.
Substance Abuse Policy: YouthBuild Louisville prohibits its employees, students, volunteers, and consultants from using, consuming, selling, purchasing, transferring or possessing alcohol, illegal or non-prescribed drugs on YouthBuild Louisville’s campus, worksite, or at any point in time of direct affiliation with YouthBuild Louisville and the services it provides.
Substance Abuse Policy:*

I understand and consent to the above statement.
Equal Opportunity Policy: YouthBuild Louisville seeks to provide opportunity to all individuals and does not discriminate on the basis of race, color, religion, sex, age, national origin, pregnancy, physical or mental disability, gender identity, sexual orientation, or veteran status.
Equal Opportunity Policy: *

I understand and consent to the above statement.
Volunteer Grievance Procedure: If a volunteer has a contention or disagreement with a policy of YouthBuild Louisville, procedure, staff person, student, or fellow volunteer, which is not suitable for resolve through open communication and mutual respect between both parties, please contact the YBL Volunteer Coordinator, to discuss and resolve the matter.
Volunteer Grievance Procedure: *

I understand and consent to the above statement.

Individual: Volunteer Sign up Form

Personal Information

Emergency Contact / Medical Information

Releases

Interests & Experience

References