Fillable Pittsfield Family Ymca Volunteer Application Form (Page 2 of 2) in pdf

o Yes o No

If Yes, date of entry: ________________________________________________ Date of discharge: ____________________________________________________

EDUCATION

Highest Education Reached: Formal education is not required to be a volunteer. We welcome experience of all kinds!

______________________________________________________________________________________________________________________________________________________________________________

Other skills (caring for children, languages, etc.) _______________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________

REFERENCES (TWO PERSONAL & ONE EMPLOYMENT )

1. Name: __________________________________________________________________________________________________________________________________________________________________

Address: __________________________________________________________________________________________________________________________________________________________________

Telephone: ______________________________________________________________ Relationship to you: ______________________________________________________________________

2. Name: __________________________________________________________________________________________________________________________________________________________________

Address: __________________________________________________________________________________________________________________________________________________________________

Telephone: ______________________________________________________________ Relationship to you: ______________________________________________________________________

3. Name: __________________________________________________________________________________________________________________________________________________________________

Address: __________________________________________________________________________________________________________________________________________________________________

Telephone: ______________________________________________________________ Relationship to you: ______________________________________________________________________

AGREEMENT

The facts set forth in my application for volunteer opportunities are true and complete. I understand that if I become a volunteer, false information on

this form or failure to disclose material facts will be considered grounds for discharge. I understand and agree that if my service as a volunteer is

accepted, there is no contract period for volunteer service and my volunteer service would be solely ‘at will’ giving either me or the Pittsfield Family

YMCA the right to terminate my volunteer service at any time without liability of obligation. In an ongoing effort to offer the best possible volunteers to

our program participants, the Pittsfield Family YMCA requires that all new and/or returning volunteers pass a CORI check before volunteering. The YMCA

provides this service at no extra charge to the volunteer and all responses are kept confidential. I further understand that, if employed as a volunteer, I

am required to abide by all established policies and procedures of the Pittsfield Family YMCA.

Your signature: ________________________________________________________________________________________________________

Date: ________________________

Parent’s or guardian’s signature: ________________________________________________________________________________

Date: ________________________

(if under 18 years old)

PITTSFIELD FAMILY YMCA

292 North Street, Pittsfield MA 01201

P 413-499-7650 F 413-443-6791