RSVP Volunteer Registration Form
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Name (First, middle, last) *
Address *
Home phone number
Cell phone number
Date of birth *
Gender *
Marital Status *
Emergency Contact #1 - Name and relationship *
Emergency Contact #1 - Phone Number *
Emergency Contact #2 - Name and relationship
Emergency Contact #2 - Phone Number
Designation of Beneficiary - Name and Relationship *
Designation of Beneficiary - Address *
Designation of Beneficiary - Phone Number *
Length of time residing in Michigan
Other states of residence *
Other names previously used (including previous married names/maiden names) *
Physical limitations: *
Previous/Current employment experience: *
Are you currently volunteering anywhere in Otsego County? If so, where? *
Are there specific agencies you are interested in volunteering for? *
Please list 2 Otsego County references: (Name/Phone number) *
Who referred you to RSVP? *
Transportation? *
Michigan Drivers License Number: *
Michigan Drivers License Number Exp. Date: *
Auto Insurance Company Name: *
I agree that if I use my personal vehicle for volunteer services, I will maintain a current, valid drivers license as well as vehicle insurance equal to or greater than the minimum limit required by the State of Michigan *
Is your spouse a veteran? *
The information requested in the next two questions are for statistical purposes as requested by various federal and state funding sources. Provisions of this information is voluntary and will be available to authorized personnel only. Are you handicapped?
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Race (check all that apply)
CONSENT AND CONFIDENTIALITY STATEMENT: I volunteer my services through RSVP and it's sponsoring agency, Otsego County United Way. I understand that I am not an employee of that agency or RSVP. hereby agree to regard all information received in the performance of my volunteer work as confidential. I further agree to respect individual rights to privacy, as well as those of the person, family, and/or volunteer station for whom I am volunteering. I understand that the volunteer station will respect my rights with regard to privacy of information. The volunteer station agrees to respect those rights in the performance of my volunteer duties and keep "professional" confidentiality in all my statements both inside and outside the station. I hereby consent to the use of my name and/or photograph by RSVP and its sponsoring agency in any of the media (newspapers, publications, television, films, videos, etc.) and in exhibits. I understand that I maintain my active status as an RSVP volunteer through a monthly time sheet report to the RSVP office. The monthly time sheet will list all the volunteer hours I have worked through the RSVP work station(s)/program(s)/project(s). hereby grant permission to RSVP to check with the appropriate authorities upon matters of record regarding my background and history as they relate to being an RSVP volunteer. I understand that if I use my personal automobile in my volunteer service, I will arrange to keep in effect automobile liability insurance equal to or greater than the minimum limits required by the State of Michigan. agree to all the terms of this Volunteer Registration Form. I understand that all the information provided/obtained in this registration will be kept strictly confidential. *
Signature (digital) *
Signature of RSVP Staff
Volunteer Interest Checklist (select all you might be interested in) *
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