Volunteer Application - Boys and Girls Club of the West Valley

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Name *

DOB

Address

Address Line 1

City

State

Zip Code

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Phone

Email *

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DL#

State

Exp. Date

Do you have any medical conditions that we should be aware of?

Yes
No

If so, please explain:

AVAILABILITY

Volunteer opportunities of interest:

Program Support
Administrative Support
Service Projects

Special skill/talent:

Preferred time frame?

Mornings
Afternoons

Preferred age group?

Elementary
Middle School
High School

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Commitment dates:

For example: June 15th – Aug 10th

Hours available:

For example: 10am – 4pm

EXPERIENCE

Please share your interest in volunteering with BGCWV

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Current Employer

Title

Does your employer have a volunteer grant program?

Yes
No
Not sure

Have you ever worked with youth?

Yes
No

If yes, please describe:

Have you previously volunteered at a Boys and Girls Club?

Yes
No

If yes, which club:

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Supervisor’s Name

Phone

REFERENCES

Reference 1

1. Name

Phone

Reference 2

2. Name

Phone

Reference 3

3. Name

Phone

Emergency Contact

Name

Phone

Relationship

Spouse
Parent
Sibling
Friend

I understand my acceptance to the BGCWV Volunteer program is dependent on my background checks. I hereby consent to permit Boys & Girls Clubs of the West Valley to contact anyone it deems appropriate to verify my suitability for volunteer service, and knowingly waive all rights to bring an action for defamation, invasion of privacy, or any other cause of action against anyone providing or seeking such information. I acknowledge that I have read this authorization and release, fully understand it, and voluntarily agree to its provisions. Hold Harmless Clause: I further agree to relieve the Boys & Girls Club of the West Valley’s Board of Directors and Staff of all liability in the event of an accident or injury to myself as the volunteer.

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Signature

Date

For statistical purposes (Optional)

Identity:

Female
Male
Non-binary
Transgender