39 Concord Road, Chelmsford, Massachusetts01824
(978) 256- 4396 (978) 256-3054 fax
Date: ______
APPLICATION
□ Volunteer
□ A Volunteer for Required Service (see page 2)
Volunteers are an important part of the programs at The Paul Center. Volunteering is a rewarding experience that benefits everyone. We ask that volunteers be at least 14 years old.
Name ______
Street Address ______
City ______State ______Zip ______
Phone ( )______Date of Birth ______
Email Address______
Please indicate your availability:
□ Daily □ Weekly □ Monthly □ Other: ______
Please list your work and/or volunteer experience, especially with children and young adults ______
______
Please list your interests, hobbies, talents, etc.
______
______
Please indicate if you hold certification in any of the following:
□First Aid□Advanced Life Saving□W.S.I.□CPR
□ASL (sign language)□Other
Please tell us which age group you would most like to work with (our students range in age from 4- 22) and any other information you feel is important.
______
______
What has motivated you to choose The Paul Center for volunteer service?______
______
What types of volunteer activities are you interested in performing?
□Work withChildren/Students□ Facility Repair □Painting □Clean Up □ Clerical □ Landscaping □ Events □ Other:______
Is your volunteer service to The PaulCenter required for school, religious or other service?
□YES□ NO
If yes, please complete the following:
Sponsoring Organization ______
Address ______
City ______State ______Zip ______
Name of Contact Person ______
Contact Person: Telephone______Email:______
Please indicate the number of hours required to volunteer: ______
Current School Grade (if applicable) ______
At the successful completion of your volunteer work, a letter will be sent to your school or organization indicating your service to The PaulCenter, upon request
Please list three references we can contact (other than parents) who have knowledge of your character, work experience and scholarship.
NAMERELATIONSHIP PHONE
1. ______
2. ______
3. ______
______
Signature of ApplicantDate
PARENTAL RELEASE (If applicable)
While the staff and administration at The Paul Center makes every effort to insure the safety of volunteers, injury to a volunteer by a student is possible. Usually any injuries are caused by scratches or bites. It is important that tetanus shots be current in the event an injury should occur. Parents of volunteers are notified if medical attention is necessary. Volunteering at The Paul Center can be a very satisfying and rewarding experience.
I have read this application and give permission for my child to volunteer at The Paul Center for Learning and Recreation, Inc.
______
Signature of Parent of GuardianDate
THE PAULCENTER IS AN EQUAL OPPORTUNITY EMPLOYER
PaulCenter Use Only
Referred By:______
Interviewed By:______
Date of Form: 6/18/09Page 1 of 3