1) Name:  

2) Address:  

3) City, State, Zip:  

4) Phone 

4a) E-mail

5) Date of Birth if under 21: 

6) Best time to call: 

7) Emergency Contact Person:  

8) Phone:  

9) What kind of transportation will you use to get to volunteer projects?:  

10) School:  

11) Grade:  

12) Please list favorite subjects or special skills:  

13) List any volunteer or work experiences you have had:  

14) List any limitations you would like us to consider in your volunteer placement:  

15) How did you hear about the Volunteer Center?

• Tri-City Herald Library Neighborhood School Friend Business Web site Other

     Specify Other    

16) Volunteer Focus - Check areas below that you may be interested in helping out.

• Animals
• Community Projects
• Emergency Assistance
• Health & Medical
• Recreation
• Sports
• TheArts
• Crime Prevention
• Environment
• Office/Clerical
• Seniors
• Volunteer Services
• Children's Programs
• Education
• Food Banks
• Personal Support
• Social Services

       Specify Other    
  

  17) Would you like to help with special projects or one day events? 

  18) Do you have a valid drivers license?  

  19) Do you have the minimum auto insurance required by WA state law? 

  20) Driver's License# 

  21) Expiration Date 

  22) I understand that if I use my personal automobile in my volunteer service, I will arrange to keep in effect automobile liability insurance equal to the minimum limits required by our state.
  

  22) Insurance Company 

  23) Insurance Agent Name: 

  24) Designation of Beneficiary 

  1) Name, Address, Relationship:  

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  I understand....

  I understand that all information on this form is voluntarily supplied and may be used and disclosed for volunteerism purposes only. I hereby volunteer my services and understand that I am not a paid employee of any agency or graoup to which I may be assigned, nor an employee of the referring agency. I understand that I may choose among the volunteer jobs referred to me and I am under no obligation to accept any placemetn unless I choose to do so.

  Volunteer Signature and Date:

  Guardian Signature and Date:

  I understand that this prelimary application is being sent through e-mail for the Volunteer Center to process my application. When the Volunteer Center schedules an interview please bring in a signed form.