Rewards Volunteer Application

Volunteer Application
Thank you for your interest in volunteering. The following information will assist us in determining your interests and abilities for a prospective assignment, and provide other information required for administrative purposes. This registration information will form part of your profile.
Are you under 18 ?*

NoYes
Your age ?*
Please enter the full name of your Parent / legal guardian*

First NameLast Name
Your Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Home Phone

Area CodePhone Number
Cell Number

Area CodePhone Number
How did you learn about the program*
Input the Referal Code if you have one*

SCREENING
Our organization seeks to protect participants, volunteers, employees and the community through appropriate screening measures. A police records check may be required and reference checks are required for all applicants. Please provide the names of two references that we may contact.

We would like to contact two references (school, business or volunteer related, no family):
Reference 1- Name*
Reference 1
Reference 1- Phone*

Area CodePhone Number
Reference 1- How do you know this reference*
Reference 2- Name*
Reference 2- Phone*

Area CodePhone Number
Reference 2- How do you know this reference*
EMERGENCY CONTACT
Name*
Relationship*
Phone Number*

Area CodePhone Number
Please list any medications, disabilities or health issues that we should be aware of in case of an emergency (allergies, contact lenses):*
COMMITMENT
By clicking on the SUBMIT BUTTON I agree to the following:
I agree to adhere to the organizations policies, rules, and regulations.

I agree to attend a formal Orientation and complete the required training.

I understand that false information on this application may be cause for termination of service.
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Volunteer Application