RSVP 2017 -VOLUNTEER SIGNATURE FORM

Steps to complete yourvolunteer registration with the for RSVP program:

Step 1: Complete the online volunteer profile at

Fill in the tab “Become a Volunteer”

Step 2: Return the filled out VOLUNEER SIGNATURE FORM to your station coordinator.

Note: All Asterisk *questions are for the support for our grant funding purposes,YOUDOhave the right to not answer those questions. The information provide on this application will be kept confidential.

VOLUNTEER INFORMATION (Required Information)

FIRST NAME / LAST NAME / E-MAIL
STREET ADDRESS / CITY / ZIP
HOME PHONE / WORK PHONE / CELL PHONE
DATE OF BIRTH
/ / / M / F / EDUCATION
HS AA BA/BS MA PHD Other
IN EMERGENCY NOTIFY / RELATIONSHIP / EMERGENCY CONTACT PHONE/EMAIL

1

ETHNICITY*

American Indian or Alaskan Native / Hispanic / Latino
Asian / Native Hawaiian or Pacific Islander
Black or African American / White/ Caucasian


1

ARE YOU BILINGUAL? Yes No If Yes, list languages______

ARE YOU INTERESTED IN SERVING ON A NONPROFIT BOARD? Yes No

ARE YOU A VETERAN? Yes No If Yes, whatbranch______

DO YOU HAVE FAMILY MEMBERS WHOARE ACTIVELY SERVICING IN THE MILITARY? Yes No

ARE YOU WILLING TO VOLUNTEER IN TIMES OF A DISASTER? Yes No

HOW DID YOU HEAR ABOUT US? (Please indicate with an “X”)

Brochure/Flyer / Radio/TV
Co-worker/Volunteer/Friend / Website
Facebook/Twitter / Workplace/or Volunteer Location
OC Register / Other

BENEFICIARY FOR RSVP SUPPLEMENTAL ACCIDENT INSURANCE

(Simply write “Estate” if you do not wish to be more specific)

NAME / PHONE/EMAIL ADDRESS

MUTUAL UNDERSTANDING

  • I understand that if I use my personal automobile to travel to and from my volunteer service that I will carry Automobile Liability Insurance equal to the minimum limits required by the State of CA.
  • I understand that supplemental volunteer insurance provided by RSVP is at no cost to me.
  • I understand that I am responsible for updating the OneOC office of any personal changes in my information, i.e. new email, phone or mailing address.
  • I understand that photographs are taken of volunteers performing their duties that are used in publications. I DO DO NOT authorize the use of my picture for this purpose (please initial).

______

VOLUNTEER SIGNATURE (Required) DATE (Required)

All volunteers will receive a RSVP Welcome Packet within two weeks of registration. In the event, step1 is not competed as instructed on this page 1 of this form,an account will be created on your behalf. This will generate a password that will be sent to your email address. This account will also allow you to register, if you so choose, for additional volunteer opportunities in the community.

For questions about the RSVP Program, please contact Abby Edmunds, Volunteer Service Manager at or call 714-597-8949.

* * * * * * * * * ** * * STATION Use Only * * * * * * * * * *
  1. Volunteer’s Start Date______(Note: Start date cannot early than signature date)
  2. Volunteer’s Position Title______(Example: RACES PD)
  3. Volunteer’s Position Title______(Example: Mentor)
STATION NAME ______Staff Coordinator Name______Date______
* * * * * * * * * ** * * * OneOC Use Only * * * * * * * * * * * *
Welcome Packet Sent Date ______OneOC Staff Name ______
Volunteer confirmed in SF ______OneOC Staff Name ______
Volunteer confirmed in VR______OneOC Staff Name ______
Check All Completed: Impact Area__, Ethnicity__, OC Location__, Photo’s Approved__ Hard Copy File__
Volunteer stop date in VR ______Termination Reason ______
Comments:

OneOC

1901 E. 4th Street, Suite 100

Santa Ana, California 92705

714-953-5757 x 150

Formerly Volunteer Center Orange County