Regular Volunteer Registration Form
Email address *
Part 1: Personal Information
Name: ( First , Middle , Last )
Your answer
Address: ( Street , City , State )
Your answer
Zip Code:
Your answer
Date of Birth
Cell-Phone Number
Your answer
Home-Phone Number
Your answer
Emergency Contact Person
Your answer
Phone Number for Emergency Contact Person
Your answer
Relation to Emergency Contact Person
Your answer
How did you find out about Confluence Community Cafe?
Part 2: Availability
Volunteer Availability
All Day
Morning & Afternoon
Afternoon & Evening
Morning & Evening
Not Available
Please, select any days of the week you are NOT available AT ALL to Volunteer:
How many hours a week are you available to volunteer?
If interested in an ongoing position, can you commit to a minimum of 2 hours a week for 3 months?
Part 3: Volunteer Interests & Abilities
Which Programs and Events are you interested in participating in?
Volunteer Interests & Opportunities
Please, select what you are interested in doing with the organization and which opportunities you would like to be apart of.
Volunteer Skills & Experience
Please, select what skills and experience you have - whether working or volunteer related.
Select Volunteer ROLES you are interested in:
In consideration of my application and permitting me to participate in Confluence Community Center activities, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: Confluence Community Center (CCC) and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; (B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in these activities, whether caused by the negligence of release or otherwise. *
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