YMIC Foundation, INC. - Volunteer Form

YMIC FOUNDATION VOLUNTEER APPLICATION

Contact Information

Name:
Home Phone:
Cell Phone:
E-mail:
Address:
City:
State:
Zip:
D.O.B.: i.e 1-24-1965
*SSN
*Please note this is only required for state required background check when volunteering in certain positions.
Do you have a valid driver’s license?
Yes No

Emergency Contact

Contact Name:
Relationship:
Phone:
Address:
City:
State:
Zip:

Volunteer Interests

Engineering Area:
Science Area:
Law Area:
General Interests:
Preferred Position:
Hours available:
Previous Experience:

Volunteer Agreement I understand that:
· The references I listed may be contacted by telephone or email.
· This application in no way obligates me to perform any volunteer service.
· All records and information gathered are the property of YMIC.
· If I decide to volunteer on an ongoing basis with any student that I have helped through YMIC, I will contact and work with YMIC Foundation before I continue to work with them.
· I understand that YMIC is not responsible, or liable, for any participant activities I continue outside of the scheduled YMIC Foundation programming.
· I hereby authorize YMIC Foundation to conduct whatever investigation it may deem necessary to determine whether I can become an effective volunteer.
· I understand that YMIC Foundation uses photos of volunteers and student participants in a variety of activities for recruiting and promotional reasons. I am willing to support their efforts. YMIC Foundation has my permission to use my name and photographs of me to promote the Agency's program.
· I understand that I must carry my own health insurance. I will not hold YMIC Foundation responsible for any unforeseen injuries or problems that may occur on the job.

By clicking submit you agree to the terms posted above