Volunteer Application
Please print clearly and fill out the application in its entirety.
Name (first, middle and last) ______
Home Address ______
City ______State ______Zip ______
Phone Numbers ______
Please include area codes cell home work
Preferred method of communication (please circle): cell home work Best time to call: ______
Male ( ) Female ( ) Email ______
Date of Birth ______T-Shirt Size ______
($10.00 payment not necessary with application)
Employer ______Position ______
Work Address ______
City ______State ______Zip ______
Why are you interested in volunteering with Noah's Ark of Central Florida?
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NA USE ONLY
Received ______Contacted ______Orientation ______T-Shirt Money ______Background Check ______
How did you hear about Noah's Ark of Central Florida? ______
I would like to be considered for the following volunteer opportunities:
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Please list any languages that you speak, read and/or write fluently, in addition to English: ______
Have you volunteered for other organizations? ___ Yes ___ No (if you checked yes, please continue below)
Organization Name: ______
Describe volunteer service below:
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Organization Name: ______
Describe volunteer service below:
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Please describe any work or personal experience you think might be relevant to our program:
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Do you have any hobbies or special talents?
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Please list two references:
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Name Relationship Time Known Contact Number
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Name Relationship Time Known Contact Number
Have you ever been charged with or convicted of the following: (please check yes or no)
a) Felony? ____ Yes ____ No
b) Any crime involving a sexual offense, an assault or the use of a weapon? ____ Yes ____No
c) Any crime involving the use, possession or the furnishing of drugs? ____ Yes ____No
d) Reckless driving, operating a motor vehicle while under the influence, or driving to endanger? ____ Yes ____ No
If you answered Yes to any of the above four items, please explain: ______
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Noah's Ark of Central Florida has my permission to verify the two references I have provided:
____ Yes ____ No
As a volunteer of this organization, I agree to abide by the policies and procedures. I understand that I will be volunteering at my own risk and the organization, its employees and affiliates, cannot assume responsibility for any liability for any accident, injury or health problem which may arise from any volunteer work I perform for the organization. I agree that all work I do is on a volunteer basis and I am not eligible to receive any monetary payment or reward. I affirm that I have answered all questions truthfully. I understand that if any portion of this application is found to be intentionally false, I may be denied the right to volunteer for Noah's Ark of Central Florida.
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Signature Date
Release for Publication
Please initial below:
I understand that, Noah's Ark, as part of their marketing program, takes photographs and electronically records the various programs and activities to use in a variety of different ways including, but not limited to, marketing materials, website illustrations, as well as social media websites. By initialing below, you may choose to grant or deny Noah's Ark permission to use photographs or videotape yourself, alone or in groups, in newspaper articles, newsletters, websites, online, brochures, special fundraising activities, scrapbook, videos and photo albums for use in public understanding and support of the Noah's Ark program. By granting permission below, you hereby release and hold harmless Noah's Ark of Central Florida from any claims, judgments, or demands which may arise from the use of the above referenced photographs and/or videotapes.
_____ "YES, I grant permission" OR _____ "NO, I deny permission"
Initial Initial
Permission to Participate and Release of Claims
Please initial below:
I acknowledge and agree that participation in activities and/or transportation with Noah's Ark is a personal choice and may involve risk of serious bodily injury including loss of life, property damage and other hazards. I understand and agree that I will not hold Noah's Ark responsible and/or liable for any injury that occurs during participation in any activity and/or transportation. I agree, on behalf of my family, heirs, beneficiaries and personal representative, to assume all the risks and responsibilities regarding any participation in Noah's Ark activities and transportation. I release and forever discharge and covenant not to sue Noah's Ark (including its Officers, Volunteers, Agents, Employees, and Board of Directors) from and against any and all liability for any and all claims.
_____ “YES, I agree"
Initial
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Signature Date
2 K.B./P.C./9.17.17