Treasure Valley Family Ymca Student Volunteer Application Page 2
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5FOR YOUTH DEVELOPMENT
FOR HEALTHY LIVING
FOR SOCIAL RESPONSIBILITY
:
Availability
Sunday time:
Thursday time:
Monday time:
Friday time:
Tuesday time:
Saturday time:
Wednesday time:
STUDENT VOLUNTEERS
If this service is to fulfill a school requirement, wil you receive school credit for your services?
Yes
No
If yes, number of hours needed
Deadline to complete hours
Name of School
Phone Number of School
Name of Teacher
COMMUNITY SERVICE:
Are you looking to complete Court Ordered Community Service Hours?
Yes
No
If yes, offense:
Number of hours needed:
Deadline to complete hours:
Parole/Probation Officer’s name:
Phone:
REFERENCES:
Please provide three names and personal letters of reference, one of which must be a relative.
Attach letters to this form.
1. Name:
Phone:
Relationship to you:
2. Name:
Phone:
Relationship to you:
3. Name:
Phone:
Relationship to you:
I understand that volunteering at a YMCA has inherent risks. I am the parent/guardian of the
minor child listed above and I hereby give permission for them to volunteer. In exchange for the
opportunity for my child to volunteer at the YMCA. I assume full responsibility for all risk of injury
or property damage arising from her/his participation. Barring significane negligence on the part
of the YMCA I release, waive my right to sure, hold harmless, and agree to indemnify the YMCA
for any injury, property damage, or claim thereof arising from said participation.
Parent Name
Parent Signature
Date
I agree that if I am allowed to volunteer at the YMCA that I will be present when scheduled, will
follow the instructions of my supervisor at the YMCA, and will follow the YMCA values of caring,
honesty, respect, and responsibility.
Student Name
Student Signature
Date
Student Volunteer App, cont.
Page 2
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