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

AVAILABILITY

Volunteer opportunities of interest:

Program Support
Administrative Support
Service Projects

Preferred time frame?

11 a.m. - 1 p.m.
1 -3 p.m.
3 p.m.-5 p.m.

Preferred age group?

Elementary
Middle School
High School

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

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SPECIAL INTEREST AND SKILLS

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 certify that the answers given herein are true and complete to the best of my knowledge. I have read and understood the volunteer guidelines and expectations. I understand my acceptance to the BGCWV Volunteer program is dependent on my background checks. I understand that if I fail to adhere to the guidelines and rules of the Boys & Girls Club of the West Valley, then I will be asked to discontinue my services at any given time. 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