Volunteer Registration Form

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					                                            VOLUNTEER REGISTRATION FORM
                                                           Volunteer Community Connections, Inc.
                                                         1750 17th Street, Suite J1, Sarasota, FL 34234
                                                          941-953-5965 phone 941-365-5718 fax
                                                                     info@VCCflorida.org
                                                               www.ConnectingVolunteers.org


Today’s Date:____________________                                  DOB:______/______/______

Salutation:______ First Name:______________________________ Last Name:_________________________________



Currently volunteering at: _____________________________________________________________________________

How did you hear about us? ___________________________________________________________________________

Employer: _________________________________________________________________________________________

Occupation (current or former):________________________________________________________________________

Special needs or physical limitations_____________________________________________________________________

Ethnicity (for statistical reporting only): White_____      Black_____     Hispanic_____ Asian_____       Other_____

Seasonal Resident?       N       Y       If yes, month of Arrival______________           Departure______________

Note: A background may be required for placement.



Local Address:_________________________________________________________________

City:_________________________________________________                     State:_________        Zip:________________

Home phone: _____________________Cell: ____________________                    Business:____________________

Email:_____________________________________________________________

Local Emergency Contact:_____________________________________________                 Phone:______________________




_________________________________________________________________________________
Volunteer’s Signature




PLEASE TURN OVER TO PAGE TWO
Time Availability (X):      Weekday: ____Days ____Evenings             Weekend: ____Days ____Evenings

                         ____One Time Events Only         ____Short Term Assignments (under 3 months)

                            ____Long Term Assignments (3+ months, 1+ hours per week, indefinitely)




                                                         Skills and Interests

 __   Aids Awareness                   __   Disaster Preparation                __   Law Enforcement        __   Senior Activities
 __   Animals/Pet Therapy              __   Disaster Response                   __   Legal Assistance       __   Special Events
 __   Artist                           __   Driver                              __   Library Aide           __   Special Olympics
 __   Arts & Crafts                    __   Editing/Writing                     __   Literacy - Adult       __   Sports Activities
 __   Arts Volunteer                   __   Entertainer                         __   Mailings Preparation   __   Tax Preparation
 __   Baby Care                        __   Environment Services                __   Marine Life            __   Teacher
 __   Blood Donor Services             __   Event Planning                      __   Marketing              __   Theater/Stage
 __   Bookkeeping                      __   Food Bank                           __   Meal Delivery          __   Thrift/Gift Store
 __   Child Care/Development           __   Fundraising                         __   Medical/Dental         __   Tour Guide/Docent
 __   Child Protection/Advocate        __   Gardening/Landscaping               __   Mentoring              __   Translator
 __   Community Support                __   Greeter/Booth Tending               __   Newsletter/Brochure    __   Tutoring
 __   Companion/Visiting               __   Handicapped Services                __   Office Work            __   Ushering
 __   Computer Literacy                __   Handyman                            __   Parks & Recreation     __   Website/Internet
 __   Construction Work                __   Healthcare                          __   Photography            __   Wildlife Programs
 __   Consulting/Business              __   Homeless Care                       __   Receptionist           __   Women's Programs
 __   Counseling/Social Work           __   Hospice                             __   Respite Care           __   Word Processing
 __   Data Entry                       __   Hospital Volunteer                  __   Retirement Centers
 __   Day Care - Children              __   Insurance                           __   School Volunteer

				
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posted:9/18/2012
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