Volunteer Application Form

Full Name *

First Name Middle Name Last Name

Primary Phone *

Alternative Phone

E-mail *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code

Date of Birth *

/ Month / Day Year

Languages

Areas of Interest (select all that apply) *

Driver (Personal Vehicle) Van Driver Companion Help at Home Grocery Shopping Handyman/woman Yard Work Office

Preferred Method of Communication

Days and times you are available to volunteer

Hobbies

Please provide 3 personal references *

Include name, phone, and email for each reference.

How did you hear about us? *

Summarize why you'd like to volunteer *

Emergency Contact *

First Name Last Name

Phone *

Relationship *

I agree to protect the confidentiality of all information pertaining to any Neighbor Network (NN) member, non-member or other volunteer associated with NN. I agree to follow and adhere completely to the program's rules and guidelines. My application submission acknowledges my agreement to adhere to this confidentiality policy.
Release of Liability: I attest that my involvement and membership in NN, a volunteer program of Aging Resources of Douglas County (ARDC), is fully voluntary and that I can decline participation at any time by contacting the office. I hereby release NN, ARDC, its staff, the board of directors, associates, clients and volunteers from all liability for any injury, medical expenses or damages related to services provided and/or completed by ARDC, NN and its volunteers. I indemnify and hold harmless NN, ARDC, its staff, board of directors, associates, clients and volunteers from all claims, demands, losses, causes of action, lawsuits, judgments, including attorneys’ fees and costs, arising out of or relating to, activities related to services provided by the organization and Neighbor Network volunteer services.
I consent to undergo a background check by Verified Volunteers. I will have the opportunity to contribute to the cost of the background check but am not obligated to do so. I will own this background report and may share it with other nonprofit organizations if I so choose. The background check results will be kept confidential.

Agreement: By submitting this application, I certify that I have read and agree to the information above and confirmed the accuracy of the information provided.

Thank you for making a difference!

Application to Volunteer 2019