Volunteer Application Form (Page 2 of 3) in pdf

VOLUNTEER APPLICATION

Rogue Valley Family YMCA, 522 West Sixth Street, Medford, OR 97501

Phone (541) 772-6295; Fax (541) 772-8427;

We appreciate your interest in volunteering at the Rogue Valley Family YMCA.

All applications are reviewed carefully but submission does not guarantee placement

in a volunteer position. Thank you for applying to be a volunteer at the YMCA.

Name: __________________________ Age: _________ Date of Birth: ____________

Present Address: ________________________________________________________

Street

City

State

Zip

Phone Number: ___________________ Email: ________________________________

Age groups you prefer to work with: _________________________________________

Do you have any physical limitations that might prevent you from engaging in physical

activities?

 NO

 YES If yes, explain: __________________________________

Why do you want to volunteer for the Rogue Valley Family YMCA? _________________

______________________________________________________________________

What are some of the talents or skills you can share as a volunteer? _______________

______________________________________________________________________

REFERENCES

LIST TWO PERSONAL REFERENCES AND ONE SHOULD BE A FAMILY MEMBER:

Name: ______________________________

Relation to you: ___________________

Phone: ______________________________ Email: ___________________________

Name: ______________________________

Relation to you: ___________________

Phone: ______________________________ Email: ___________________________

I certify that the information on this application is true, complete, and correct. I

authorize the Rogue Valley Family YMCA to perform the necessary background checks to

determine my qualifications for volunteer work and the safety of YMCA participants.

Signature: _______________________________________

Date: _____________

If the person applying as a volunteer is under the age of 18, a parent/guardian must

sign below. Your signature indicates this application is made with your full approval.

Signature: _______________________________________

Date: _____________

Volunteer Application Form Page 2