Name* First Last Email* Phone*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Gender*FemaleMaleDo not wish to reportDate of birth* MM slash DD slash YYYY Emergency Contact Name* First Last Are you inquiring for an individual or an organization?* An Individual An Organization Emergency Contact Phone*Have you ever been convicted of a crime (felony or misdemeanor) other than a minor traffic violation?* Yes No Place of Employment What volunteer activities interest you most?* Social Programs Recreational Programs Events Committee Chairs (Buddy Walk, Calendar Gala) Please indicate the days you are usually available to volunteer.* Sunday Monday Tuesday Wednesday Thursday Friday Saturday Please indicate the times you are usually available to volunteer.* Morning Afternoon Evening About You...Please share anything you'd like us to know about you.Skills and Experience* Athletics or Coaching Child Care Creative Arts Dance or Gymnastics Photography or Videography Tutoring or Teaching Writing In which areas do you feel you have moderate to excellent skill? Check all that apply.Other Skills Is there a skill you are passionate about not mentioned above? Are you fluent in any of the following languages?* Chinese French Japanese Spanish N/A Please select all that applyVolunteer Agreement* I Agree I agree to serve as a volunteer and commit to the following: 1. To perform my volunteer duties to the best of my ability. 2. To respect those we serve. 3. To meet time and duty commitment, or to provide adequate notices so that alternate arrangements can be made. 4. To maintain open communication with my supervisor and volunteer coordinator regarding any issues or concerns. 5. To adhere to rules and procedures, including confidentiality of agency and client information. I understand and agree that submitting this application form does not automatically register me as a DSABV volunteer, and that there may be certain qualifications I must meet before I may begin volunteering, including but not limited to the acceptance of established volunteer policies and procedures, and successful completion of a background check. I give DSABV permission to take photographs and/or video of me, and I grant DSABV full rights to use such photographs and/or video of me, and any reproductions or adaptations thereof, for fundraising, publicity or other purposes, including but not limited to the right to use them in printed and online publicity, social media, and press releases. Furthermore, I agree to release, defend, hold harmless and indemnify DSABV from any and all claims involving the use of my picture or likeness. I recognize and acknowledge that there are certain risks of physical injury to volunteers providing and/or engaging in volunteer activities, and I voluntarily agree to assume the risk of all injuries, death, damages, or loss, regardless of severity, that I may sustain as a result of such volunteer activities. I furthermore agree to waive and relinquish all claims I may have as a result of such volunteer activities against DSABV, or any of DSABV's respective officers, employees, agents, and/or other volunteers, collectively or individually. By submitting this form, I attest that the information I have provided on the form is true and accurate to the best of my knowledge.Background Check Agreement* I Agree I understand that all volunteers 18 years of age and over will be subjected to a criminal background screening.Section Break
