Volunteer Interest Survey | YMCA of the Fox Cities

First Name:

Last Name:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone

Are you 18 years of age or over?

If you are not at least 18 years old, please have your parents digitally sign this form.

Yes

Are you a YMCA Member?

Yes

YMCA facility you would like to volunteer at:

Please list any skills or qualifications that would pertain to your volunteers at the YMCA.

If you are leading a larger group or business that has committed to volunteering at the YMCA, please complete this section.

Group/Business Name

How Many Volunteers are Participating?

Date and Time of Volunteer Event

YMCA Location(s):

Emergency Contact

First

Last

Phone Number

Relationship

VOLUNTEER STATEMENT

I hereby affirm that the information given by me on this application for volunteering is complete and accurate. I understand that any falsification or omission will be immediate grounds for dismissal. I authorize the investigation of all statements contained in this application. I understand a background check may be required. I understand this agreement and have read it carefully before signing.

Volunteer Statement

VOLUNTEER STATEMENT

Parent Signature (if under age 18)

Sign above