VOLUNTEEN Application

Volunteer Center of San Gabriel Valley

119 W Palm Ave, Monrovia, CA  91016  Phone: (626) 256-8187  Fax: (626)256-8243

Email: voffice2@ci.monrovia.ca.us  Website: www.volunteercentersgv.org

 

Please Print!  Return to address above.                                          Today’s Date ___________

 

 

Name_________________________________________

             First                    Middle Initial                    Last

 

 

Mailing Address _________________________________

 

 

City________________ ST_________    Zip___________

 

 

Home Phone_____________________

 

Cell Phone _______________________

 

Email Address__________________________________

 

 

Birth Date______/______/_______     Male  __Female

                     Month         Day       Year                   Check One

 

 

School___________________________  Grade_______

 

 

 

 

 

I understand that all the information on this form is voluntarily supplied and may be used and disclosed for volunteer purposes only.  I also agree to release and hold harmless the staff, the volunteers, and the board of directors of the Volunteer Center of San Gabriel Valley from any and all liability for disclosing this information to agencies and their agents who request volunteer assistance or injury incurred while on volunteer assignment.  I hereby volunteer my services and understand that I am not a paid employee of any agency or group to which I may accept assignment, nor am I an employee of the Volunteer Center of San Gabriel Valley.

 

By becoming a VOLUNTEEN, I understand that I will have the opportunity to participate in many individual and group volunteer projects.  By signing this application, I (parent/guardian, if member is under 18) grant permission for participation in events without requiring additional permission forms.  I also grant the Volunteer Center of San Gabriel Valley permission to use photographs taken of member at volunteer activities for publication to promote volunteerism.  THIS APPLICATION MAY BE REVIEWED BY REPRESENTATIVES OF THE VOLUNTEER CENTER OF SAN GABRIEL VALLEY AND/OR OTHER FUNDING SOURCES FOR THE PURPOSES OF MONITORING AND EVALUATION.

 

_______________________________________             _______________________________________

VOLUNTEEN Applicant’s Signature                                   Parent/Guardian’s Signature

Do you drive?_________

 

Do you have physical limitations that may prohibit you from participating in volunteer activities?______

 

Please list hobbies and/or talents that you might be willing to share______________________________

__________________________________________

 

How did you hear about the VOLUNTEEN Program?

______________________________________

 

Do you belong to other school, church, or civic clubs?  Please list:

__________________________________________

__________________________________________

 

Please list a personal reference to who we can contact.

 

Name_____________________________________

Address___________________________________

City_________________ST_______Zip__________