VOLUNTEEN

Council Application

Please Print Clearly

Student's Name:                                                             Grade in Sept:           Birth Date:                               

 

Address:                                                                          City:                                                        Zip:                  

 

Phone:                          Cell:                              Email:                                                                                          

 

Other School or Community Club Affiliation(s):                                                                                              

 

Volunteer Experience:                                                                                                                                            

 

T-shirt Size: Adult S  M  L  XL  XXL  

 

School Name:                                                    School Representative:                                              

 

Phone:                          Email:                                                      Website:                                              

 

Student

I understand and agree to my responsibilities as a representative of the Volunteer Center VOLUNTEEN Council.  I also understand that I must pay a $20 non-refundable membership fee each year.  I understand that I am expected to attend all scheduled meetings and complete my expected duties.

 

Student Signature                                                                                                   Date:                              

 

Parent

I understand my child’s responsibilities as a representative of the Volunteer Center VOLUNTEEN Council.  I also understand that we must pay a $20 non-refundable membership fee each year.  I also understand that payment plans are available if needed.

 

Parent Signature                                                                                                     Date:                              

 

School Representative (Activities Director, Club Coordinator, teacher, etc.)

I understand my responsibilities as a partner with the Volunteer Center VOLUNTEEN Council.   I also understand that the school has the option to pay their representatives membership fees. 

 

School Representative’s Signature                                                                      Date:                              

_________________________________________________________________________________

 

Payment Method:

I have included a check for $20, payable to The Volunteer Center

Please charge my credit card $20

I would also like to make a tax-deductable donation of $____ in support of the Youth Program

 

Name on Credit Card: _________________________________________             Amount: $________

 

Credit Card #: ________________________________________________            Exp. Date: ________

 

Signature: _________________________________________________

VOLUNTEEN Council

Permission Slip, Medical & Media Consent Forms

 

I give permission for my child                                                          , to attend Volunteer Center of San Gabriel Valley VOLUNTEEN Council meetings and events at The Volunteer Center located at 119 W Palm Ave, Monrovia, CA  91016, or other sites sponsored by The Volunteer Center.                            (please initial)

 

I, the undersigned parent or guardian of                                                                   do herby authorize and give my consent to emergency medical, surgical and dental diagnostic procedures or treatment including, but not limited to physical examination, inoculations and therapeutic treatment of my above-named child whenever any of the foregoing is deemed necessary by a licensed physician/dentist.  A consent in advance for such treatment is authorized by Section 25.8 of the Civil Code of California.

 

Parent/Guardian Signature                                                                                        Date:                             

 

Child's Name                                                                                    Date of Birth                                            

Home Address:                                                                                                                                  

High School attending:                                                                     Grade in Sept:               

Parent 1/Guardian 1                                                           Phone                                         

Parent 2/Guardian 2                                                           Phone                                         

Other Emergency Contact                                                               Phone                                                     

Allergies:                                                                                                                                                          

 

I also give The Volunteer Center permission to use photographs, video, or other forms of media of my child for publication materials.                        (please initial)