Volunteer Application - Chance Shelter

First Name

Last Name

Email address(required)

Phone

Address:

City/Town:

Home Phone

State

Cell

Zip

Emergency Contact Person

Phone

Relationship

Age (if under 21):

Name of Parent or Guardian (if under 18):

Have you ever volunteered before?

Yes

If yes, where:

Reason(s) for wanting to volunteer:

Other

Are you a full-time resident?

Yes

If not, what months are you available?

What days are you available to volunteer: (specify morning, afternoon, evening)

Do you have transportation to and from your volunteer job?

Yes

How did you hear about our volunteer program:

Please Read The Following Terms Carefully. You Are Agreeing To Them When You Sign Below.

I fully understand, acknowledge and agree to the following:

Chance Shelter is under no obligation to select me to serve as a volunteer and may decline to select me in its sole discretion. I will not begin to serve as a volunteer until advised by Chance Shelter that I have been approved to volunteer.

Yes

Chance Shelter is under no obligation to allow me to continue to serve as a volunteer and may terminate my service as a volunteer at any time in its sole discretion. I will immediately discontinue service as a volunteer when requested to do so by Chance Shelter.

Yes

Chance Shelter is authorized to obtain from the Arizona Department of Public Safety a criminal history report regarding me. Chance Shelter is under no obligation to share such report with me. It may use the results of that report in determining whether it is in the best interests of the shelter to select me to serve as a volunteer or to terminate my service as a volunteer.

Yes

I have been convicted of the following crimes (list any and all criminal convictions whether a felony, misdemeanor or petty crime in Arizona or anywhere else. (If none, print NONE). Note: You do not need to list civil traffic infractions.

I have the following criminal charges pending against me in Arizona or anywhere else (if none, print NONE):

The information I have provided in this application is true, accurate, and complete. I understand, acknowledge, and agree that Chance Shelter will not allow me to serve as a volunteer and may terminate my service as a volunteer if the information I provided is inaccurate, incomplete, or inconsistent with the information the shelter receives from the Arizona Department of Public Safety. Should I be charged or convicted of a crime anywhere while serving as a volunteer I will immediately notify Chance Shelter of the charge and/or conviction in writing.

Yes

By typing my full name I acknowledge that I am over 18 years old or that I am under 18 years old but over 13 years old and have my parent or guardian’s permission to volunteer at Chance Shelter. I also understand that volunteering for the shelter could present some risk or harm to me. I (and my parent or guardian if they sign below) agree to hold harmless Chance Shelter, the volunteers, and the Board of Directors for any injury that I may suffer while volunteering at the Shelter.

Yes

Name

Parent / Guardian Signature (If under 18)

Date

This field should be left blank

VOLUNTEER REGISTRATION

Please Read The Following Terms Carefully. You Are Agreeing To Them When You Sign Below.