Volunteer Intake Form

Volunteer Application

Background
Name *

First Name Last Name

Mailing Address *

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

Cell Phone *

- Area Code Phone Number
Alternate Phone *

- Area Code Phone Number
Email *
example@example.com
Preferred Communication *
Education Level *
Employment *
Current Employer *
Gender *

Male Female
Birthdate *

- Month - Day Year
Date
Native Language *
Other Languages *

Emergency Contact & Previous Volunteer Experience
Emergency Contact *

First Name Last Name
Emergency Contact Phone Number *

- Area Code Phone Number
Emergency Contact Email *
example@example.com
Previous Volunteer Experience *
Why Do You Want To Volunteer? *

Availability
Start Date *

- Month - Day Year
Date
Hours per week *
Days available *

Monday Tuesday Wednesday Thursday
Do you have any upcoming vacations or commitments that will interrupt your schedule? *

References

Please list two local, non-family members
Reference 1 *

First Name Last Name
Reference 1 Email *
example@example.com
Reference 2 *

First Name Last Name
Reference 2 Email *
example@example.com

Please initial if we can use your photo in our marketing materials

Clear
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. *

Clear
Release from Liability: I am aware that as a volunteer I expose myself to potential hazards which include but are not limited to: accidents, illness, property damage, etc. I am voluntarily participating in this service with the knowledge of the potential hazards involved and hereby agree to accept any and all risks of injury. I agree that my assignees, heirs, distributes, guardians and other legal representatives will not make a claim against, or sue for injury or damage resulting from the negligence or other acts, howsoever caused, by any employee, agent, or volunteer contractor of the organization as a result of my participation as a volunteer. I hereby release Teton Literacy Center and its officers, volunteers and agents from all actions, claims, or demands that I, my assignees, heirs, guardians and legal representatives now have or may hereafter have for injury resulting from my participation as a volunteer. If under 18, parent signature required to assure Release of Liability for their child. *

Clear
Applicants under the age of 18 need parent/guardian permission to volunteer. By signing below you authorize your child to volunteer at Teton Literacy Center.

Clear
Should be Empty:

Volunteer Application

Emergency Contact & Previous Volunteer Experience

Program Interests

Availability

References