Online New Volunteer Application
Welcome to the Worthington Resource Pantry (WRP). Our volunteers are one of our most important assets, we could not carry out our mission without them. We hope that your time with us will be meaningful to you as we all learn and grow to build a stronger community. Please allow ten (10) business days for a reply after submission.

Please note: If you are under 18 years of age, please complete the WRP Youth Volunteer Application located at http://goo.gl/forms/5VFeK1OJpk.

Contact Information
Title
Last Name *
Your answer
First Name *
Your answer
Middle Initial
Your answer
Street Address, Apt # *
Your answer
City, State *
Your answer
Zip Code *
Your answer
Telephone Number *
Your answer
Email Address
Your answer
Preferred Contact Method *
How do you want us to communicate with you?
Additional Information
Employer/College
Your answer
Retired *
Are you 18 years old or older? *
(If answered no, then stop. View and complete the WRP Youth Policy and Application at http://goo.gl/forms/B61tBeQRic )
Date of birth (enter as mm/dd/yyyy - e.g. 12/31/2014) *
Your answer
Are you meeting required service/community hours *
How many service hours are you required to complete
Your answer
List any applicable affiliations
Churches, Schools, or Community Groups
Your answer
Emergency Contact - Last Name *
Your answer
Emergency Contact-First Name *
Your answer
Emergency Contact-Street Address *
Your answer
Emergency Contact-City, State *
Your answer
Emergency Contact-Zip Code *
Your answer
Emergency Contact-Telephone Number *
Your answer
Emergency Contact-Email Address
Your answer
Availability
Day/Time Choice *
Please indicate the times you are usually available to volunteer.
Required
Preferred working group *
How do you prefer to work: (Check all that apply)
Required
Interests *
Check mark the areas you are interested in volunteering. (Check your top four, at most. You will have other opportunities after you begin volunteering)
Required
Volunteer Experience & Special Skills or Qualifications
Other Volunteer Experience
Describe any past or other volunteer experience you would like us to know.
Your answer
Other Languages
List the languages that you speak and/or write fluently.
Your answer
Specials skills/experience
Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including computer skills, hobbies or sports that would benefit WRP.
Your answer
How Did You Hear About Us
Check all that apply
WORTHINGTON RESOURCE PANTRY RELEASES AND AGREEMENTS..
Please read each releases and agreements noted below then enter today's date and your name in the signature field. This must be completed prior to volunteering.
1. Waiver and Release Of Liability Form
I will abide by the rules and policies of the Worthington Resource Pantry (WRP). Worthington Resource Pantry is not liable for any injuries, damages, losses, judgments, costs, or expenses whatsoever which I might suffer or sustain in connection with the performance of my volunteer duties with the WRP. I hereby release, indemnify, and hold harmless the WRP, its directors, officers, employees, agents, and volunteers and their heirs, successors, and personal representatives from and against liability. I have accurately and truthfully completed this release.
2. Release for Use of Name, Likeness, Quote, and Photograph
I provide WRP and other such persons affiliated with WRP the absolute right and permission to use my name, likeness, quote(s), and photograph(s) made of or collected from me, in whole or in part, throughout the world for the purpose of advertising, publicity, or any other lawful purpose, in any media now known or ever developed. I agree that I will not hold WRP or anyone who deserves permission from either of them, responsible for any liability resulting from the use of my name, likeness, quote(s), and photograph(s) in accordance with these terms.
Worthington Resource Pantry Volunteer Agreement and Signature
I agree to abide by the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

I agree to attend orientation and training within one month of my first volunteer opportunity.

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.

Date *
MM
/
DD
/
YYYY
Signature *
Enter your full name as indication that you have accurately and truthfully agreed to Release 1, Release 2 and the Volunteer Agreement listed above.
Your answer
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