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Online Youth 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: This form is for youth between the ages of 14 and 17 years of age, only.

Contact Information
Title (Mr., Mrs., Ms.)
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
School
Your answer
Is your school in the Worthington School District?
Are you volunteering to meet a community/school service requirement?
If you answered yes above, how many community/school service hours are required?
Your answer
Date of birth (enter as mm/dd/yyyy - e.g. 12/31/2014)
Your answer
List any applicable affiliations
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
How many hours do you wish to work per month
Your answer
Please indicate the times you are usually available to volunteer.
Please indicate the times you are usually available to volunteer. Note: the pantry is only open on the 3rd and 4th Saturdays of the month.
Required
Other Volunteer Time
Please indicate the day/time, other than open pantry hours, you wish to volunteer.
Your answer
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 about.
Your answer
Other Languages
List the languages that you speak or write fluently.
Your answer
Lift Limit
Choose the limit you are most comfortable lifting.
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 YOUTH RELEASES AND AGREEMENTS
Please read each release and agreement noted below then enter today's date, the parent name and the youth name in the signature field. Releases and agreements must be completed by parent and youth prior to volunteering.

The Worthington Resource Pantry Youth Policy and other information appear on the page following this application.

1. Youth Waiver and Release Of Liability Form
Parent: I give permission for my child to serve as a youth volunteer with the Worthington Resource Pantry (WRP). I understand that my child (if under 18) must work alongside other qualified WRP volunteers of at least 18 years of age at all times, and I give the adult volunteers permission to supervise and direct my child’s activities.

Youth: 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 which I might suffer or sustain in connection with the performance of my volunteer activities with the WRP.

Parent & Youth: I hereby release, indemnify and hold harmless the Worthington Resource Pantry, its directors, officers, agents, employees and volunteers and their heirs, successors, and personal representatives from and against liability

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 to agree 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
Parent 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 for your youth.
Your answer
Youth 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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