MEDFORD BGCMS VOLUNTEER APPLICATION
(Volunteers must be at least 18 years of age)
Email address *
PART A. VOLUNTEER INFORMATION
Full Name *
Your answer
Please indicate what you would prefer your potential name tag to say *
Your answer
Date of Application *
MM
/
DD
/
YYYY
Street Address and Unit Number (Ex: 123 Main St. Apartment #3) *
Your answer
City of Residence (Current) *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone # *
Your answer
Cell Phone # *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
T-Shirt Size *
Required
Please Select the Boys and Girls Club site you are applying for: *
Required
Group/Program Name (Are you volunteering as an individual or as part of a class, club, or other group? Please specify) *
Your answer
What do you hope to gain from your time as a potential volunteer at the Boys & Girls Clubs? *
Your answer
Occupation *
Your answer
Employer/School *
Your answer
Are you CPR/First Aid certified? *
Are you willing to submit to a National Criminal and Sex offender Background check? *
Do you speak any languages other than English? If yes, please specify *
Your answer
How did you hear about/find us? *
Your answer
Part B. AVAILABILITY
The Boys & Girls Clubs are open Monday through Friday from 2:30 – 6:00 PM. Please indicate days and times you would be available to volunteer.
Which days are you available? *
Required
Please indicate what time you are available for on which days *
Your answer
From the above availability, please list two days of the week & times that you would most prefer *
Your answer
Part C. PROGRAM PREFERENCE
Please check all boxes that apply when considering your preferred age group to work with *
Required
Please indicate which school subjects you feel most confident in *
Your answer
Please select the Program areas/activities where you would be able to contribute: *
Required
Please clarify any of the above selections as necessary:
Your answer
PART D. VOLUNTEER WAIVER
Please read the following waiver and check the boxes below to indicate your agreement with the statements: *
Required
Please indicate whether or not you authorize the use of your photograph or video footage for the publicity and public relations purposes of the Boys & Girls Clubs of Medford & Somerville *
Required
THE FOLLOWING FIELDS ARE A VOLUNTARY SELF-IDENTIFICATION (THESE ARE COMPLETELY CONFIDENTIAL- FOR STATISTICAL USE ONLY)
Gender
Your answer
Veteran Status
Age
PLEASE SELECT ONE OF THE DESCRIPTIONS BELOW CORRESPONDING TO THE ETHNIC GROUP WITH WHICH YOU MOST IDENTIFY:
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