ADULT VOLUNTEER APPLICATION (Over age 18) DATE: ______

PERSONAL INFORMATION

Name (Full – Last, First, MI):
Street Address: / City: / State: / Zip:
Home Phone: / Cell Phone: / E-Mail Address:
Date available for service: / Have you ever submitted an application for employment or volunteer work with this agency?
 No Yes If yes, which location (s)?
Level of Eduation Completed: / Name of school: / Special Training:
Birthday (year optional): / Site Preference:

EMERGENCY CONTACT

Full Name:
Last / First / M.I.
Address:
Street Address / Apartment/Unit
City / State / ZIP Code
Primary Phone: / ( ) / Alternate Phone: / ( )
Relationship:

AVAILABILITY

Please fill in the days and times that you are available to volunteer.*
Monday
/
Tuesday
/
Wednesday
/ Thursday /
Friday
Times
*Club Hours vary according to location. Clubs are closed on weekends.
Total number of hours each week you are available to volunteer: ______
Estimated length of commitment (e.g. 3 months, 6 months, a year, etc.): ______
* In order for all Volunteers to be identifiable by kids and community members, volunteers are required to wear a Volunteer
T-Shirt at the cost of $7.00 per shirt. What is your T-shirt Size?(Please Circle)
Adult: S M L XL XXL

INTERESTS

Are you interested in serving as a year –long weekly volunteer? Yes  No
If no, on what date(s) can you volunteer? ______
What area(s) of programming interest you most?
_____ Education/Tutoring _____ Games Room/Play Field _____ Career Development _____ Fundraising/Events
_____ Fine Arts/Crafts _____ Technology/Computers _____ Translation _____ Marketing
_____ Sports/Fitness _____ Teen Programs _____ Admin Support _____ Music/Performing Arts
_____ Health Programs _____ Environmental Studies _____ Resource Development Other______

EXPERIENCE/SKILLS

Please list previous volunteer experience, working with youth, and/or special skills valuable to Boys & Girls Club (Foreign language skills, CPR, crafts, sports, computer skills, hobbies, etc.): ______
Please list reasons for wanting to volunteer at Boys & Girls Club: ______

PERSONAL REFERENCES

Name / Address / Relationship / Phone Number

READ CAREFULLY

I authorize Boys & Girls Clubs of Central Sonoma County (BGCCSC) to investigate all statements in this application. I understand that satisfactory results from a background screening will be required before I can begin volunteering for BGCCSC.
I further understand that any false or misleading statements will be sufficient cause for rejection of my application or immediate dismissal during my service with BGCCSC. I also authorize BGCCSC to supply information about my employment record, in whole or in part, in confidence to any prospective employer, government agency, or other party having a legal and proper interest and I hereby release BGCCSC from any and all liability for its providing this information.
I understand that BGCCSC has the right to modify its policies without giving me any notice of the changes. Except as specifically set forth herein, no other representations have been made to me.
In consideration of volunteering at BGCCSC, I, intending to be legally bound, hereby for myself, my heirs, executors and administrators waive and release any and all claims that I may have against BGCCSC for any and all injuries or accidents suffered during my volunteer time at BGCCSC or any of its events or functions.
I hereby acknowledge that I have read and understand the preceding statements.

DATE: ______SIGNATURE OF APPLICANT: ______

To begin the volunteer application process, please complete this application.

For questions please feel free to contact our administrative office at 707-528-7977.

Boys & Girls Clubs of Central Sonoma County

P.O. Box 7460

Santa Rosa CA 95407