RSVP Volunteer Enrollment Form

RSVP does not share personal volunteer information - confidentiality is enforced

* Name

* Date

* Address

* Phone

* City, Zip

Apartment#

E-Mail Address

* Date of Birth

* Referred/Recruited By

Are you volunteering at this time?

Yes

No

If yes, where do you volunteer?

Are you interested in an additional assignment?

Yes

No

Please list education, training, certifications, etc.

Please list previous/current places of employment/positions

List medical conditions that may preclude certain assignments

Please check skills and interests that you may be willing to invest in your community.

Please check RSVP Special Initiatives that you may be willing to support.

SCI - shares information on immunization	West Nile Virus - Teaches WNV defense
Rockin' Readers - reading to students	Homeland Security - preparedness, drills
Professional Consultants - marketing, plans

Other skills/interests not listed:

* What type of transporation will you use to reach your volunteer site?

* "I understand that if I use my personal automobile in my volunteer service, I will arrange to keep in effect automobile liability insurance equal to the minimum limits required by the state"

Agree

Don't Agree

Designation of Beneficiary for RSVP Supplemental Accident Insurance (Active volunteers are provided free supplemental insurance)

* Name

* Relationship

* Address, City, State, Zip

Please check all that apply to you: (data is for statistical analysis with respect to the success of the Affirmative Action programs only. Submission of this information is totally voluntary).

*

I grant RSVP permission to publish any pictures that may be taken of me:

Yes

No

Typing in your name is your verification that you are submitting the Volunteer Registration Form.

* Signature

* Indicates Response Required

Accounting/Finance	Boards/Commissions	Children/Youth Programs
Nursing Home Visitation	Workshop/Class Instructor	Immunization Outreach
Driver/Transportation	Emergency Assistance	Environmental Projects
Food Banks/Meal Delivery	Fundraising	Health Education
Special Events	Hospice	Literacy
Education	Public Safety	Data Entry
Docents/Guides	Translation	Youth Mentor

Male	Female	Single	Married Widowed	African-American
Asian	White	Hispanic	Native American	Other