Volunteer Registration

Primer nombre*
Apellido*
DOB*
Month
Day
Año
Email*
Teléfono*
Habla a*
Dirección Línea de dirección 2 Ciudad Estado Código postal
Please choose volunteer interest(s) (check all that apply)**
Please choose volunteer interest(s) (check all that apply)*
- Construcción de canastas de cuidado
- Recreación adaptativa
- Administrador / Oficinista / Entrada de datos
- Recaudación de fondos
- Otro
Please choose days of the week you are generally available to volunteer (check all that apply)*
Please choose days of the week you are generally available to volunteer (check all that apply)
- Weekdays
- Weekends
¿Eres una persona con discapacidad?*
Tipo de discapacidad*
Descripción de la lesión*
Fecha de la lesión / diagnóstico*
Month
Day
Año
Causa de la lesión*
¿Su familiar (o ser querido) tiene alguna discapacidad?*
Cuéntanos más
Género*
Do you speak any additional languages?*

Languages*

Emergency contact name*
Emergency contact phone*
Are you volunteering for a class or project?*
School*
If other, which school*
Area of study*
Professor's name*
Number of hours needed*
Do you have trouble safely lifting and carrying items that are over 30 pounds?*
Do you feel comfortable safely lifting (50+ lbs) ex: Transferring?*
Do you have special accommodation requests?*
Special Accommodation Request*
Do you have any criminal history?*
Provide a full explanation of the conviction or pending charges. (A conviction or pending charges will not necessarily disqualify you from volunteering. Each situation will be considered on its own merit.)
¿Como supiste de nosotros?*
Are you under the age of 18?
Parent/Guardian Name*
Relationship*
ONCE THE BELOW "REGISTER" BUTTON IS PRESSED, YOU WILL BE REDIRECTED TO THE ONLINE SIGNATURE PAGE. A SIGNATURE IS REQUIRED FOR THIS APPLICATION
If APPLICANT IS UNDER THE AGE OF 18, A PARENT OR GUARDIAN SIGNATURE MUST SIGN THIS FORM.
I agree to be on-site and provide supervision during the volunteer service*
- si