Ymca Of Ithaca & Tompkins County Volunteer Application Form
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1
2Volunteer Application
Date
Received_________
Personal Information
Name __________________________________________________
DOB ____________________ Over 18:
Sex:
Address ______________________________________________________________________________________________________________________________________
Street
City
State
Zip
Email ________________________________
Phone _________________________
Emergency Contact _______________________________________________________________________________________ Phone __________________
Name
Relationship
Background Experience (paid or volunteer)
Job Title
Activities/Responsibilities
Date (to-from)
Name & Phone of
Organization/Company
-
-
-
-
three people
References: Please list
who are not relatives who could attest to your abilities.
Name
Address
Phone Number or Email
Relationship/
Years Acquainted
Opportunities: What skills or interests would you like to share?
Program
√
Special Events
√
Facility
√
Aquatics
Court Sports
Tri-for-the-Y
Committee member
Cleaning
Fitness
Referees
Kids to Camp Golf Outing
Administrative
Electrical
Child Care
Healthy Kids Day
Marketing
Plumbing
After School
Family Fun Nights
Social Media
Construction
Youth Sports
Santa 5K
Fundraising
Outdoor Ed
Personal Background Checks: The YMCA may conduct background and other investigations from public and/or
private information regarding any part of my personal background. I will keep the YMCA informed as to each
and any change in any of the foregoing information, without the need for any request on the part of the YMCA
Public Relations Agreement: The YMCA of Ithaca & Tompkins County reserves the right to use your name
and/or photograph/video for pubic relation and marketing purposes and recognition for all YMCA employee
and volunteer positions
Hold Harmless Agreement: I, as a volunteer at the YMCA of Ithaca & Tompkins County and any of its program
sites, shall hold harmless and defend the YMCA of Ithaca & Tompkins County and its officers, employees,
agents, and elected officials for any inquiry or death to you or damage to your property arising out of
activities herein, with the exception of negligence, on the part of the YMCA.
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