Volunteer Application Form - Girl Scouts Of The Missouri Heartland Page 2
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Please list two references who are NOT family or relatives (current or former). At least one reference
should be community-related.
1. Name _________________________ E-mail _______________________________________
Home Phone _______________ Cell Phone ______________ Work Phone _______________
2. Name _________________________ E-mail _______________________________________
Home Phone _______________ Cell Phone ______________ Work Phone _______________
Our organization is committed to creating a safe environment for girls and adults. As such, we
will perform a background check on all operational volunteers.
Signature
I authorize Girl Scout employed staff to verify any and all information listed on this application and that a copy of this form shall act as
the signed original and has the same validity. I certify that my answers to the preceding are correct to the best of my knowledge. I
understand that misrepresentation or omission of facts requested may be considered justification for dismissal if discovered at a later
date. If appointed as a volunteer, I agree to abide by the philosophies stated in the Girl Scout Promise and Law, to abide by the
Policy and Procedures for operational volunteers of the council, to register with the Girl Scouts of the USA, and to fulfill the volunteer
responsibilities to the best of my ability. I authorize the council to conduct a full and complete background search.
Signed ________________________________________ Date _____________
For Office Use Only
□
□
Appointed
Yes
No If yes, appointed as ________________________________________________________
Appointment letter signed ______________________________________________________________________
Date of Application ___________________________________________________________________________
Please return to:
Girl Scouts of the Missouri Heartland
210 S. Ingram Mill Rd., Springfield, MO 65802
Phone: 877-312-4764 / Fax: 417-862-4120
Girl Scouts of the Missouri Heartland, Inc.
T 877-312-4764 ● F 417-862-4120 ● ●
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