volunteer form

Date
*
Full Name
*
Email Address
*
Address
*
- Street Address
- Address Line 2
- City
- State / Province / Region
- Postal / Zip Code
- Country
Phone Number
*
Birthdate
*
Occupation (or student)
*
Employer (or school)
*
Under 18 Parent/Guardian Information & Authorization
Parent/Guardian Full Name
Parent/Guardian Phone Number
I am the parent/guardian listed above and I authorize the applicant to provide volunteer services

Yes
Emergency Contact Name (not self)
*
Emergency Contact Phone Number
*
List 3 references
Full Name/Relationship
*
Phone Number
*
Full Name/Relationship
*
Phone Number
*
Full Name/Relationship
Phone Number
*
Please give a brief statement about why you would like to volunteer with Aspiring Attitudes
*
By choosing the “Confirm” selection below I affirm that I have read the terms and conditions below and that the information I have given is true and complete.
*

Confirm
Please click on the checkbox to continue
*

Terms and Conditions

I understand that:

* The information that I have provided may be verified and I give permission to Aspiring Attitudes to make

inquiry of others concerning my suitability to act as an Aspiring Attitudes volunteer, and I release

from liability any person giving or receiving such information.

* In the course of volunteering with Aspiring Attitudes, I may be dealing with confidential information

and I agree to keep said information in the strictest confidence.

* The relationship between Aspiring Attitudes and the volunteer is an 'at will' arrangement

and that it may be terminated at any time without cause by either the volunteer or Aspiring Attitudes.

* I grant Aspiring Attitudes permission to use my likeness, voice, and words in television, radio, film, social media,

or in any form to promote activities of Aspiring Attitudes.

* By choosing the "confirm" section above, I affirm that I have read the above and that the

information I have given is true and complete to the best of my knowledge.