03 rsvp volunteer enrollment form
Post on 22-Mar-2016
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RSVP Volunteer Enrollment FormPositive Maturity, Inc.
Please print and complete all sections.
Name: ________________________________________ Birth date: ___________________________
Street Address: _________________________________ City, Zip: ___________________________
Mailing Address: _______________________________ City, Zip: ___________________________
Phone: ______________________ _ Email Address: ________________________
Cell Phone: _________________________________
Temporary Resident? Yes _____ No _____ If yes, date leaving: _________________________
Out-of-State Address: __________________________ City, State, Zip: _________________________
Ethnic Group: Caucasian _____ African-American _____ Hispanic _____
Education: Grade School _____ High School _____ College _____
Business Classes _____ Other ______________________
Veteran? Yes _____ No _____
Do you drive your own car to volunteer? Yes _____ No _____
If yes, driver’s license #: _________________ State: _________ Exp. Date: ________________I understand that if I use my personal automobile to and from my volunteer station, I will arrange to keep in effect automobile liability insurance equal to, or greater than, the minimum required by the state.
AUTO insurance company: _______________________________________________________
Emergency Contact: ________________________________ Phone: _____________________
Beneficiary for RSVP’s Supplemental Accident Insurance:
Name: _______________________________________ Relationship: ___________________
Address: __________________________________________ Phone: ________________________
Employment Experience: ________________________________________________________
Skills, Interests, Languages: ______________________________________________________
Enrollment Form Template
(RSVP Enrollment Form, Continued)
Volunteer Experience: __________________________________________________________
Preferred Volunteer Assignments: __________________________________________________
___________________________________________________________________________
SPECIAL ON-CALL LIST: Would you like to be on a list that we call when local non-profit groups need one-time assistance with special events or fundraisers?
Yes _____ No _____ Days or Hours Available for on-call: _____________________________
Signature of Volunteer Date
Signature of RSVP Coordinator Date
FOR OFFICE USE ONLY!
Station(s) Assigned: (1) BHN#
(2) BHN#
(3) BHN#
Job Assignment Title(s): (1)
(2)
(3)
Date Assigned:
Entered in Computer:
Entered by:
Enrollment Form Template
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