Mounds View Wellness Committee Student Volunteer Form printable pdf download

Mounds View Wellness Committee

Student Volunteer Form

Name:

__________________________________________________________________

Address:

_______________________________________________________________

City:

_______________________________ State: __________ Zip: __________

Day Phone:

____________________________ Evening Phone: ____________________

E-mail address:

Please identify your current high school: (Select one)

Mounds View High School

Irondale High School

Mounds View Area Learning Center

Oak Grove High School

Which locations are you willing to volunteer at? (Check all that apply)

Bel Air Elementary School YMCA School-Age Care

Island Lake Elementary School YMCA School-Age Care

Pike Lake Education Center YMCA School-Age Care

Pinewood Elementary School YMCA School-Age Care

Sunnyside Elementary School YMCA School-Age Care

Turtle Lake Elementary School YMCA School-Age Care

Valentine Hills Elementary School YMCA School-Age Care

Please describe your availability (before school, after school & summer opportunities):

When are you available? Include all days of the week and hours you are available.

____________________________________________________________________

How many hours are you able to volunteer:

Each week:

__________________________________________________

Each month: __________________________________________________

Please describe why you would like to volunteer with the YMCA:

__________________________________________________________________________

References:

Please provide at least 2 additional adult references (teacher, coach or advisor):

Name

Phone Number

1. __________________________________

__________________________

2. __________________________________

__________________________

______________________________________

Student Signature

Date

By signing, you are giving permission to be contacted by a Mounds View Community Education

employee who will help to coordinate a volunteer opportunity. You are hereby notified that the

YMCA of St Paul may obtain a criminal background check for the purpose of evaluating you for

certain volunteer positions. You also understand that submitting this application does not

obligate you as a volunteer with the YMCA of St Paul

Mounds View Wellness Committee Initiative (2008)

(Return to your teacher/advisor or Jason Hedrix in Community Education)

Mounds View Wellness Committee Student Volunteer Form

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