EmailMe Form - VOLUNTEER APPLICATION

FULL NAME *

YOUR ADDRESS *

Street Address

CITY, STATE, ZIP *

PHONE NUMBER *

EMAIL *

IF UNDER 18, DATE OF BIRTH

PARENT'S NAME

PARENTS NUMBER

JUNIOR VOLUNTEER REQUIREMENTS

FCDACS Volunteers must be at least 14 years old. Junior Volunteers are defined as volunteers who are between the ages of 14 and 17. Every volunteer must attend an orientation and interview prior to scheduling hours. All junior volunteers must demonstrate the ability to act responsibly and to follow rules and guidelines.

PARENTS SIGNATURE

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*SIGNATURE REQUIRED

AVAILABILITY

FCDACS is open Monday – Friday 9 am – 6 pm & Saturday 11 am – 3 pm
Please let us know your availability to ensure we are able to meet your needs

DAYS OF THE WEEK *

COURT ORDERED

please check this box: If you are Court-Ordered to complete community services

INTERESTS

Please indicate which areas you are interested in below, please note that your help is not limited to these options and we are always open to hearing new ideas.

DAYS OF THE WEEK *

OTHER:

example: Joe, age 10

EMERGENCY CONTACT

Please provide the following information in case of an emergency

NAME

PRIMARY PHONE

### - ### - ####

SECONDARY PHONE

### - ### - ####

RELATIONSHIP

BACKGROUND INFORMATION

Please provide accurate and honest information

HAVE YOU EVER BEEN CONVICTED OF A FELONY? *

Yes

No

IF YES, WHEN WAS IT, WHAT WAS THE CHARGE, AND IN WHAT COUNTY? *

AGREEMENT & SIGNATURE

Please provide accurate and honest information

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. By signing this application I also agree to follow all FCDACS policies and procedures should I be chosen as a volunteer. *

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SIGNATURE REQUIRED

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age or disability.

Thank You for your interest in volunteering with us!