Volunteer Registration Interest Form

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All interested volunteers are required to fill out this form. Completion of this form is not a guarantee the opportunity to volunteer for the Youth Impact Center, Inc. or its programs.

Email *

First Name *

Last Name *

Date of Birth *

YYYY

Street Address *

City *

State *

Zip Code *

Cell Phone *

Email Address *

Please select which area(s) you are interested in volunteering:
*

Tutoring

Wrestling

Mentoring

7-on-7 Football

Special Events

Required

Have you volunteered for the Youth Impact Center in the past?
*

I have volunteer experience. If Yes list below, if No skip.

Organization 1 Name

Organization 1 Contact Person and Information

Organization 1 Start Date to End Date

Organization 1 Duties Performed

Organization 2 Name

Organization 2 Contact Person and Information

Organization 2 Start Date to End Date

Organization 2 Duties Performed

Do you have any children in any YIC programs? *

Child(s) Name(s)

What qualities and special traits will you bring to Youth Impact Center and its programs? *

Describe your previous work with children. *

Please list other skills, experience, certifications, etc. that qualify you as a YIC volunteer: *

Have you ever been formally disciplined by a youth program either as a coach, parent, volunteer or observer? If so, please explain the disciplinary action, organization, and date. *

Please list one personal and one professional reference. Please do not include any relatives.

Reference # 1 First and Last Name *

Reference # 1 Phone Number

Reference # 1 Email Address *

Reference # 1 Years Known *

Reference #2 First and Last Name *

Reference #2 Phone Number *

Reference #2 Email Address *

Reference #2 Years Known *

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