Volunteer Application Form
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Volunteer Name
Contact Information (include email)
Date of Birth
MM
/
DD
/
YYYY
Previous Volunteer Experience
Language/s spoken
Days Available For Volunteer Work
Clear selection
How Many Hours are you available per week
Physical Limitations
Valid Drivers License #
Reason For Volunteering
References: One or more personal references with contact information.
Preferred Volunteer Area
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Emergency Contact (Name-Phone-Relationship)
Liability Release: As a volunteer of Bell-Yeager/Vision 21 CDC I agree to abide by all policies and procedures as spelled out in the volunteer handbook. I understand that I volunteer at my own risk and neither the organization nor its employees assume any liability for any accidental injury or health problem arising from volunteer work I perform for the organization. I agree that all work I do is on a volunteer basis and I am not eligible to receive any monetary payment or reward.
Volunteer Signature  and Date *
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