Volunteer Registration Form




First Name
Last Name
Phone
Cell Phone
Email
Date of Birth (mm/dd/yy)
Sex

Address

Address 2

City
State
Zip/Postal

Do you request mileage reimbursement?
If yes, please complete the following:
Driver's License Number
Driver's License Expiration Date
Insurance Agent

Contact Name in Case of Emergency

Relationship

Emergency Contact Phone Number

Beneficiary's Name for RSVP Accident Insurance

Beneficiary Relationship

Beneficiary Phone Number

Beneficiary Address

Address 2

City
State
Zip/Postal

How did you find out about RSVP? (check all that apply) Friend/Family
RSVP StaffNewspaper
Radio
Television
RSVP Volunteer
Employer
Civic Organization
Place where I volunteer
Church / Synagogue
Community or Senior Center
Volunteer Center / 2-1-1
Community Event
Website / Search Engine
Other

Ethnicity (optional)

Where are your currently volunteering?

Past/Present Occupation

Interests/Skills (check all volunteer opportunity areas that are of interest to you)
Administrative Programs (accounting, Data Entry, Office Assistant, Receptionist, etc.)
Arts and Culture (docent, entertainment, museum work, theater work, usher, etc.)
Education (library, literacy, mentoring, preschool, reader, special education, tutoring, computer literacy, etc.)
Outreach (advocacy, information table, health fairs, speakers bureaus, special events, etc.)
Environment (animal care, environmental awareness, land restoration, nature conservation, recycling, neighborhood restoration, etc.)
Health (caregiving, exercise, HIV/AIDS, hospice, hospitals, immunizations, mental health, mental retardation, nursing home, respite care, etc.)
Human Services (care calls, child abuse, driving/errands, homelessness, hotline, independent living, recording for the blind, food bank/delivery, senior centers, etc.)
Marketing / Public Relations (graphic artist, media, newsletter/brochure design, web design, fundraising events, etc.)
Professional (volunteer coordinator, tax consulting, management consulting, boards, physician/RN, counseling, etc.)
Public Safety (crime prevention, disaster preparedness,/relief, elder abuse, sexual abuse, victim assistance, etc.)
Other

By submitting this form, you are agreeing to the terms of this agreement.