VOLUNTEER INTAKE FORM

DISCLAIMER: Thank you for your interest in volunteering for [ORGANIZATION NAME]. This form is used to collect information about volunteers and used for internal purposes only. The information you provide is confidential and will be treated accordingly.

VOLUNTEER INFORMATION

Name: _____________________
Street Address: __________________________________________
City: _____________________ State: _____________________ Zip Code: ________
E-Mail: _____________________ Phone: _____________________
Date of Birth: ____________

EMERGENCY CONTACT

Emergency Contact Name: _____________________
Relationship: _____________________
E-Mail: _____________________ Phone: _____________________

AVAILABILITY

List the days and times you are available to volunteer:

______________________________________________________________________

INTERESTS AND QUALIFICATIONS

Skills & Qualifications: ________________________________________________
Highest Level of Education: _____________________________________________
Driver’s License: ☐ Yes ☐ No

ACKNOWLEDGMENT

I recognize that the opportunity to participate in the [ORGANIZATION NAME] volunteer program may involve physical labor and may carry a risk of personal injury. I hereby agree to assume all risks which may be associated with my participation.

I hereby release, discharge, waive, and relinquish all claims, liabilities, and damages I may sustain from bodily injury, personal injury, or property damage, and hold harmless the [ORGANIZATION NAME], its officers, directors, employees and agents.

Signature: ______________________ Date: ______________________

Print Name: ______________________