Court Referred Community Service Volunteer Application Page 2
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2List any physical or health restrictions that might impact your work as a volunteer: _______________________________
__________________________________________________________________________________________________
I am able to begin on _____/_____/_____ and will be available on the following days and times
Monday
___:____ am/pm to ___:____ am/pm
Tuesday
___:____ am/pm to ___:____ am/pm
Wednesday
___:____ am/pm to ___:____ am/pm
Thursday ___:____ am/pm to ___:____ am/pm
Friday
___:____ am/pm to ___:____ am/pm
Saturday
___:____ am/pm to ___:____ am/pm
Sunday
___:____ am/pm to ___:____ am/pm
Please refer to City of San Diego Park and Recreation Department Information for Court Referred Community
Service Volunteers sheet for information on appropriate attire, etc.
How did you hear about the Park and Recreation Department’s Volunteer Program?
City Employee
School Bulletin/Flyer
City of San Diego Website_______________
Friend /Relative Volunteer San Diego Website
Employer_______________
Judge/Court
City Employee
Volunteer Fair__________________
Other _________________ Association with the program _____________
I understand that as a volunteer I am representing the City of San Diego and will adhere to program guidelines.
Applicant’s signature _______________________________________________Date _____/_____/_____
Volunteers, who are minors, 17 years of age and under, must have parental/legal guardian consent prior to volunteering.
Parent/Legal Guardian’s signature _____________________________________Date _____/_____/_____
Please complete and bring this form, your Court Documents and the Court Referred Community Service
Volunteer Participation Agreement with you and submit to on-site Supervisor prior to beginning your Community
Service hours.
For more information, please visit
or contact the Park and Recreation Department
Volunteer Office at (619) 533-4017.
Return application to volunteer site of interest or to main office:
City of San Diego
Park & Recreation Department -Volunteer Office
202 C Street, MS 804C, San Diego, CA 92101
Or fax to Park & Recreation Department Volunteer Office at (619) 525-8224
Office Use Only
Date Started _____/_____/_____
Site: __________________________________
On Site Supervisor: _________________________
OFFICE USE ONLY Date Started _____/_____/____
Site _______________________________________ ______ On Site Supervisor ____________________________________
OFFICE USE ONLY Date Started _____/_____/____
Updated 3/2010
Site _______________________________________ ______ On Site Supervisor ____________________________________
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