VOLUNTEER ENROLLMENT FORM

Name________________________________________________________ Date __________________________

Address_____________________________________________________________________________________
City_______________________________________ State___________________ Zip______________________
Home Phone_________________________ Work Phone_____________________ Cell Phone_______________

Emergency Contact Name __________________________________________ Phone______________________

SKILLS AND INTEREST

………………………………………………………………………………………………………………..
Education background
High School Undergraduate GED
Junior College Graduate Other

Current occupation____________________________________________________________________________

Hobbies, skills, interests

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

Previous volunteer experience

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

Preferences in volunteering
Working one-on-one with a single client Doing research, training, or an individual
Working one-on-one with a group of clients project
Working directly with a staff person as a an Public Speaking, fundraising, etc
assistant No preference
Other

AVAILABILITY
………………………………………………………………………………………………………………..
At what times are you interest in volunteering?

Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays Sundays

AM/PM AM/PM AM/PM AM/PM AM/PM AM/PM AM/PM

Do you have reliable transportation? Yes/No

BACKGROUND VERIFICATION
………………………………………………………………………………………………………………..
Have you ever been convicted of a criminal offense? Yes/No
Have you ever been charged of neglect, abuse, or assault? Yes/No
Has your driver license ever been suspended or revoked in any state? Yes/No
Do you use illegal drugs? Yes/No

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Do you have any physical limitations or are you under any course of treatment which might limit your ability to
perform certain types of work? Yes/No
PERMISSION TO PERFORM BACKGROUND CHECK
………………………………………………………………………………………………………………..
I hereby allow Daystar Ranch to perform a check of my background, including

Criminal record
Driving record
Past employee/volunteer history
Personal references
Physician or Therapist

I understand that I do not have to agree to this background check, but that refusal to do so may exclude me from
consideration for some types of volunteer work.

I understand that information collected during this background check will be appropriately limited to determining
my suitability for particular types of volunteer work and that all such information collected during the check will
be kept confidential.

I herby also extend my permission to those individuals or organizations contracted for the purpose of this
background check to give their full and honest evaluations of my suitability of the described volunteer work and
such other information as they deem appropriate

Sign_______________________________________________ Date____________________________________

Please list two non-family members whom we might contact:

Name_____________________________________________ Phone____________________________________
Name_____________________________________________ Phone____________________________________

………………………………………………………………………………………………………………..

How did you hear about us?

Position description Family/Friend/Co-workers
Advertisement Client of Agency
Volunteer Center/Website Posting Employee of Agency
Website Other

PARENTAL CONSENT
………………………………………………………………………………………………………………..
I understand that my child named above wishes to be considered for volunteer work and I hereby give my permission for
them to serve in that capacity, if accepted by the agency. I understand that they will be provided with orientation and
training necessary for the safe and responsible performance of their duties and that they will be expected to meet all the
requirements of the position, including regular attendance and adherence to agency policies and procedures. I understand
that they will not receive monetary compensation for the services contributed.

Parent Name______________________________________ Signature___________________________________________

Relationship to Applicant _________________________Phone_______________ Date______________________________

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