Name_____________________________ Home Phone_____________ Work Phone_______________

 

Address______________________________________________________________________________

 

Optional Information (please circle):

Gender:    F         M

Ethnicity:            White               Black               Hispanic          Asian                Native American

Age:     Under 21        21-30               31-40               41-50               51+

 

If you have an age preference for your volunteer focus, please indicate:

Children___________ Seniors__________ Teens__________ Adults________ No Preference_______

 

Do you have any limitations we should be aware of? ________________________________________

If yes, please specify. _______________________________________________________________

What type of volunteer activities are you interested in? ______________________________________

________________________________________________________________________________

 

What skills and interest would you like to share? ___________________________________________

_______________________________________________________________________________

 

Do you have any past volunteer experience? If so, please elaborate. ______________________________

_________________________________________________________________________________

 

When are you available for volunteer services?

Days:    Mon.                Tues.                Wed.                Thurs.               Fri.                   Sat.                  Sun.

Hours: ___________________________________

 

Professional Reference:            Name: ____________________________ Phone: ________________

                                                Company: _______________________________________________

 

Personal Reference:                    Name: ____________________________ Phone: ______________

                                                Relationship: ____________________________________________

 

Emergency Contact: Name___________________________________ Phone: ________________

 

How did you learn about volunteering for the Longmont YMCA? ____________________________

______________________________________________________________________________

I certify that the information I have given is true.  If accepted, I agree to adhere to the rules/regulations of the Longmont YMCA.Volunteer Signature (Parent or guardian if under 18)

______________________________________________