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, Relationship, and Cell Phone Number

Emergency Contact Mailing Address, City, State, and ZIP Code

Volunteer Interests

Tutoring Math-Science-English

Event Planning

Program Management

General Interests

Preferred Position

Hours, Days, and Months Available

Previous Experience

To work with children in Pennsylvania and our YMWIC Scholars, you must have current Child Background Clearances (www.compass.state.pa) which include the Child Abuse History Clearance, PA State Police Criminal Record Checks for Volunteers (SPA-164A), and FBI Fingerprinting. Do you have your clearances? If not, have you completed your online application? You must have current clearances to volunteer in YMWIC Foundation, Inc.

YesNo

Please list three references. Include their connection to you, length of the relationship, and their contact information (mailing address, phone number(s), and email address).

Volunteer Agreement

I understand that:
· The references I listed may be contacted.

· 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 Foundation’s programs.

· 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.