v o l u n t e e r i n t a k e f o r m
Name: __________________________________________________ Address: _____________________________________________________
Phone Number: _________________________________________
(City, State, Zip)
Alternate/Cell Number: _________________________ Email Address: ________________________________________________________
Type of Service:
Thrift Shop Volunteer
Housing Work Day
Court-Ordered Community Service
Scholastic Community Service
What Date Do You Plan to Start Volunteering? _____________________________
Any health issues we need to know about? _____________________________________________________________________________
Emergency Contact Name: __________________________________ Emergency Contact Phone: _____________________________
Days of the Week You Are Available to Volunteer: (select one or more)
Hillcrest Platte County Thrift Shop Projects: (select one or more)
Getting to Know You
Birth Date: _____________________
Employer/School: ______________________________________________________Occupation: __________________________________
Previous Volunteer Experience: ________________________________________________________________________________________
Church/Business/Organization Affiliation: _______________________________________________________________________________
What Location Would You Like to Volunteer:
Platte City Thrift Shop
South Platte Thrift Shop
Platte City Housing
South Platte Housing
Liability Release and Volunteer Guidelines
1. Hillcrest is not responsible for injuries that occur while volunteering.
2. Volunteers understand that they may deny the participation of an activity for any reason, unless there is signed
3. Photographic images and film might be recorded while volunteers are at Hillcrest. It is up to the individual to alert
the manager if he or she does not grant consensus for images to be obtained for future usage.
4. All Hillcrest facilities are smoke-free.
5. Volunteers may use their discretion when interacting with the public. However, since volunteers are representing
Hillcrest, they must behave in a way that corresponds to our mission statement.
*Budget Counselors and Mentors will be subject to a background check.
As a Volunteer for Hillcrest Platte County, I Have Read and Understand the Above Statements:
Name: ___________________________________________ Date: ____________________