ASAS HI - YOUTH Volunteer Application Form

YOUTH Volunteer Application Form

for applicants 17 years old and younger (MUST BE COMPLETED WITH PARENT/GUARDIAN)
APPLICANT INFORMATION
Applicant's Full Name*

First NameLast Name
Applicant's Phone Number*
Please enter a valid phone number
Applicant's Email*
jdoe@aloha.com
Applicant's Address*

Street Address

Street Address Line 2

CityState

Zip Code
Are you presently attending High School?*

YESNO
If YES, name of High School:
If YES, current grade
If YES, please provide the name of one of your High School Teachers who can provide a reference for you

PrefixFirst NameLast Name
If YES, please provide the phone number of one of your High School Teachers who can provide a reference for you
Did you take part in an ASAS Program in Middle/Intermediate School?*

YESNO
If YES, name of school:
EX: Jarrett Middle School
If YES, what school year:
EX: 2021-2022
I confirm that I am under 18*

YESNO
All volunteer applicants 18 and OVER must submit an ADULT Volunteer Application

Please click the link below to navigate to the ADULT Volunteer Application

https://form.jotform.com/asashawaii/ADULTvolunteerapp
Because ASAS work in conjunction with the Department of Education, all adult volunteers will be required to undergo a State and Federal background check. All volunteers who are under 18 will be required to undergo a State and Federal background check when they reach the age of 18. At that time, ASAS will provide instructions and will pay for said backgrounds checks.
When will you be 18?*

MonthDayYear
18th Birthdate
MEDICAL INFORMATION
List and medical problems/conditions*
Allergic to any medications?*

YESNO
If YES, please list Medications:
Dietary Restrictions/Allergies*

YESNO
If YES, please list restrictions/allergies
EMERGENCY CONTACT INFORMATION
Emergency Contact's Full Name*

First NameLast Name
Emergency Contact's Relationship*
Emergency Contact's CELL Phone Number*
Please enter a valid phone number.
Emergency Contact's HOME/WORK Phone Number
Please enter a valid phone number.
AVAILABILITY

Please list your available hours for each day. Our programs take place on weekdays, but there may be occasional weekend opportunities. We require a minimum commitment of 20 hours/quarter.
What school/program would you like to volunteer at?*
What dates would you start your volunteerism?*

MonthDayYear
Start Date
What dates would you end your volunteerism?*

MonthDayYear
End Date
PARENT LIABILITY/PARENT AUTHORIZATION
In consideration of my minor/ward being allowed to volunteer at the After-School All-Stars (ASAS) Program, its relatedevents and activities, I, the undersigned, acknowledge, appreciate, and agree that:

1. FOR MYSELF, SPOUSE AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN ANDUNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERS, AND ASSUME FULLRESPONISIBLITY FOR MY CHILD’S VOLUNTEERISM; and,

2. I willingly agree to comply with the program’s stated and customary terms and conditions for my child’svolunteering. If however, I observe any unusual significant concern in my child’s readiness for volunteering and/or inthe program itself, I will remove my child from volunteering and bring such to the attention of the nearest officialimmediately; and,

3. I, for myself and of behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMIFYAND HOLD HARMLESS ASAS, their officers, officials, agents and/or employees, other participants, sponsoring agencies,sponsors, advertisers, and if applicable, owners, and leasers of premises used for the activity (“RELEASEES”), WITHRESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property, WHETHER ARISINGFROM THE NEGLIGENCE OF THE RELEASEEES OR OTHERWISE, to the fullest extent per-mitted by law.I HAVE READ THIS RELEASE OF LIABLITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, ANDUNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILYWITHOUT ANY INDUCEMENT.
Do you agree and accept the PARENT LIABILITY/PARENT AUTHORIZATION statement above?*

YESNO
Parent/Guardian's Signature

Clear
Today's Date*

MonthDayYear
Today's Date
CONSENT FOR TREATMENT
I understand that in case of emergencies, ASAS will make every effort to contact the parent(s)/guardian(s) before any treatment is given. In the event that we cannot be contacted, I hereby authorize the physician or hospital selected by ASAS to hospitalize, secure treatment for and to order injection, anesthesia, or surgery for my child. It is further understood that I (the parent/guardian) will assume full responsibility for any such treatment, including the payment of all costs and transportation and will hold the ASAS their officers, officials, agents and/or employees, harmless there from.
Do you agree and accept the CONSENT FOR TREATMENT statement above?*

YESNO
Parent/Guardian's Signature

Clear
Today's Date*

MonthDayYear
Today's Date
AGREEMENT AND SIGNATURE
By submitting this volunteer 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.

I agree, that if I am selected to be a volunteer at After-School All-Stars Hawaii, I will volunteer for at least 20 hours per quarter, said hours will be at the convenience of the program.
Do you agree and accept the AGREEMENT AND SIGNATURE statement above?*

YESNO
YOUTH Volunteer Applicant's Signature

Clear
Today's Date*

MonthDayYear
Today's Date
Parent/Guardian's Signature

Clear
Today's Date*

MonthDayYear
Today's Date
Should be Empty:

YOUTH Volunteer Application Form

APPLICANT INFORMATION

MEDICAL INFORMATION

EMERGENCY CONTACT INFORMATION

AVAILABILITY

PARENT LIABILITY/PARENT AUTHORIZATION

CONSENT FOR TREATMENT

AGREEMENT AND SIGNATURE