Volunteer

Your Name (required)

Home Phone (required)

Cell Phone

Your Email (required)

Address (required)

City (required)

State (required)

Zip Code (required)

Date of Birth

Do you have a valid driver's license
YesNo

Emergency Contact

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Emergency Contact Address

City

State

Zip Code

Volunteer Interests

Tutoring Math-Science-English

Event Planning

Program Management

General Interests

Preferred Position

Hours Available

Previous Experience

Volunteer Agreement

I understand that:
· The references I listed may be contacted by telephone or email.
· This application in no way obligates me to perform any volunteer service.
· All records and information gathered are the property of YMWIC.
· If I decide to volunteer on an ongoing basis with any student that I have helped through YMWIC, I will contact and work with YMWIC Foundation before I continue to work with them independently.
· I understand that YMWIC is not responsible, or liable, for any participant activities I continue outside of the scheduled YMWIC Foundation programming.
· I hereby authorize YMWIC to conduct whatever investigation it may deem necessary to determine whether I can become an effective volunteer.
· I understand that YMWIC Foundation uses photos of volunteers and student participants in a variety of activities for recruiting and promotional reasons. I am willing to support their efforts. YMIC d.b.a. YMWIC Foundation has my permission to use my name and likeness to promote the Agency’s program.
· I understand that I must carry my own health insurance. I will not hold YMIC d.b.a. YMWIC Foundation responsible for any unforeseen injuries or problems that may occur during my volunteer activities.
By clicking submit you agree to the terms posted above.