Summer Youth Volunteer Application
Thank you for your interest in volunteering with ICAN. To volunteer you must complete the following application. The application will be filed and you will be contacted a week before our next orientation date that take place quarterly. The current scheduled orientation dates are:


Summer   -  May 22nd, 2019 -4- 5 pm - Application due by May 15th
If this application has been submitted after May 15th you will be put on a waiting list to attend the June 6th 4-5pm orientation. Please keep an eye on your email.


All youth applicants under the age of 18 must have parent permission. Attached to this survey you will find a permission slip that will require a parent signature. You must be a minnimum age of 15 to volunteer without a parent accompanying you.

If you have any questions please contact the Philanthropy Coordinator Raven Jordan at Raven@icanaz.org or 480-874-7580.

NOTE: All information will remain confidential.

First Name Middle Initial *
Last Name
Birthday (Minimum age to volunteer is 15) *
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Address, City, State, Zip
Email *
Home Phone
Cell Phone *
Gender
Cultural Background
Schedule and Interests
Why are you interested in volunteering with ICAN? *
Days Available to Volunteer (Check all that Apply) *
Required
Frequency *
What shift are you able to volunteer? *
Comments reguarding your schedule?
Skills/ Interest (Check all that Apply) *
Required
What are your scheduled summer vaction dates?
Do you have a special interest or a special talents that you would like to teach the youth? (Examples- Music, Soccer Club, or STEM)
Education and Experience
School Name and Grade *
School Clubs
Language Spoken Fluently
List any experience you have working with children in a volunteer or work-related capacity. (Agency, Position, Dates and Description)
Emergency Contact
Please provide information to for an emergency contact.
Last Name, First Name *
Phone Number (List as many as possible Cell, Home, Work) *
Relationship to You *
Do you have Health Insurance *
Name of Health Insurance Agency
Physical Limitations
Mission Statement
ICAN provides free, comprehensive programs that empower youth to be productive, self-confident, and responsible members of the community.
RELEASE AND WAIVER OF LIABILITY
The undersigned hereby acknowledges and agrees as follows with respect to participating in activities in connection with ICAN’s Volunteer Program:
In connection with my voluntary involvement in activities undertaken for and with the participation and support of ICAN, a non-profit, 501©3 organization, I hereby agree, for myself, my heirs, assigns, executors, and administers to release and discharge ICAN, its officers and directors, employees, agents and volunteers from all claims, demands and actions from injuries sustained to my person and/or property as a result of my involvement in such activities, whether or not resulting from negligence, and I agree to release and hold ICAN, its officers and directors, employees, agents, and volunteers harmless from any cause or action, claims or suit arising therefrom. I hereby attest that my attendance and involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the foregoing terms and conditions of this release. I also grant full permission for ICAN to use photographs of me and quotations from me in legitimate accounts and promotion of ICAN activities.
I hereby confirm, represent and warrant that I have never been convicted of, or charged with, a violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape or any sexual offense, nor have I been ordered by a court to receive psychiatric or psychological treatment in connection therewith.
ACKNOWLEDGEMENT OF CONFIDENTIALITY
I acknowledge this responsibility and agree not to divulge any information that I have acquired due to my involvement in ICAN, either verbally, in print, or through any other means. This agreement also extends to the prohibition of any disclosures, although not individual specific, in which the identity of the children, their families, and/or staff persons may not readily be ascertained.
OPERATIONAL ACKNOWLEDGEMENT
I agree to accept all responsibilities of serving as a volunteer in the Program, notifying the Volunteer Coordinator of any cancellations or changes in my schedule. I understand and agree that I am enrolling in the volunteer program and that all of my responsibilities are subject to evaluation. I agree to document the hours spent as a volunteer with ICAN. I agree to respect the human rights and dignity of persons receiving services from ICAN and to work cooperatively with ICAN employees.
This document shall be deemed to have been executed in the state of Arizona and accepted according to all of the above terms and conditions.
Commitment
I understand that ICAN relies on volunteer support and that I am committing to volunteer for a minimum of six months.
Parent or Guardian Permission
Please download the following permission slip and have parent or guardian sign it. You can submit it digitally below (preferred) or bring it with you to your scheduled orientation. This slip is required for youth applicants. (To download slip- Right Click on image with cursor and Save it to your computer. You can also screenshot it on your mobile device.)
Permission Slip
Upload Parent Permission Slip
I have read and understand the following. *
Date *
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Name *
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