Volunteer Application Form

Volunteer Application
Full Name*

First NameMiddle NameLast Name
Cell Phone*
Home Phone*
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Languages
Areas of Interest (select all that apply)*

Driver (Personal Vehicle)Van DriverCompanionHelp at HomeHandyman/womanYard WorkOfficeLarkspur Meal DeliveriesOther
Preferred Method of Communication
Days and times you are available to volunteer
Hobbies
Please provide 3 personal references. Please only 1 family member.*
Include name, phone, and email for each reference.
How did you hear about us?*
Summarize why you'd like to volunteer*
Emergency Contact*

First NameLast Name
Phone*
Relationship*
I agree to protect the confidentiality of all information pertaining to any ARDC member, non-member, or other volunteer associated with the volunteer program. I agree to follow and adhere completely to the program's rules and guidelines. My application submission acknowledges my agreement to adhere to this confidentiality policy.
Release of Liability: I attest that my involvement as a volunteer is fully voluntary and that I can decline participation at any time by contacting the office. I hereby release ARDC, its staff, the board of directors, associates, clients, and volunteers from all liability for any injury, medical expenses, or damages related to services provided and/or completed by ARDC and its volunteers. I indemnify and hold harmless ARDC, its staff, board of directors, associates, clients, and volunteers from all claims, demands, losses, causes of action, lawsuits, judgments, including attorneys’ fees and costs, arising out of or relating to, activities related to services provided by the organization and the volunteer services.
I consent to undergo a background check, and I will have the opportunity to contribute to the background check cost but am not obligated to do so. I will own this background report and may share it with other nonprofit organizations if I so choose. The background check results will be kept confidential.

Agreement: By submitting this application, I certify that I have read and agree to the information above and confirmed the accuracy of the information provided.

THANK YOU FOR VOLUNTEERING!
Electronic Signature (type your name to sign)*
Thank you for making a difference!
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