AMERICAN RED CROSS YOUTH VOLUNTEER APPLICATION FORM

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					  AMERICAN RED CROSS YOUTH VOLUNTEER APPLICATION FORM

PERSONAL INFORMATION:
Last Name:                            First Name:                         Middle:


Street:                               City, State:                        Zip Code:


Birth date:                           Home #:                             Cell #:

Email (NECESSARY TO RECEIVE INFORMATION ABOUT UPCOMING VOLUNTEER EVENTS:



EXPERIENCE:
(Include both paid and volunteer work experience, beginning with most recent)
Organization Name:                                        Responsibilities/What You Did:

Street Address:                                            •

City, State, Zip Code:                                     •
Phone #:
                                                           •
Supervisor:
                                                           •
Dates: From ____________________ To
___________________

Organization Name:                                        Responsibilities/What You Did:

Street Address:                                            •

City, State, Zip Code:                                     •
Phone #:
                                                           •
Supervisor:
                                                           •
Dates: From ____________________ To
___________________


EDUCATION:
Institution Name:                                        City, State:

Dates: From ___________________ To ___________________
Institution Name:                                      City, State:
Dates:   From ___________________ To ___________________
EMERGENCY CONTACT INFORMATION: REQUIRED
Name:                                           Street Address:

Relationship :                                  City, State, Zip Code:

Phone #:


FLUENT LANGUAGE SKILLS:



AVAILABILITY:
(Please include the hours you are available to volunteer)
  Monday          Tuesday        Wednesday          Thursday          Friday          Saturday         Sunday
  Morning         Morning         Morning            Morning         Morning          Morning          Morning
  Afternoon       Afternoon       Afternoon          Afternoon       Afternoon        Afternoon        Afternoon
  Evening         Evening         Evening            Evening         Evening          Evening          Evening

YOUTH VOLUNTEER OPPORTUNITIES:
(See attached for youth volunteer descriptions)
   Blood Drive Caller                                        Special Events Volunteer
   Blood Drive Volunteer                                     Scrubby Bear Instructor
   Creative Writer                                           Club Red Youth Council Committee Member
   Measles Initiative Volunteer                              Office Assistant
   Youth Representative at Community Events/Health Fairs

WHY DO YOU WISH TO VOLUNTEER WITH THE AMERICAN RED CROSS?
(Optional)




I do hereby give the American Red Cross permission to inquire into my educational background, references,
driving record, police records, employment, and/or volunteer history. I further give permission to the holder of
any such records to release the same to the American Red Cross.

I do hereby hold the American Red Cross harmless from any liability, whether civil or criminal that may arise as
a result of the release of this information about me. I further hold harmless any individual, agency, business, or
corporation that provides information or documents to the above-named American Red Cross unit. I
understand that the American Red Cross will use this information as part of its verification of my volunteer
application and periodically for evaluation purposes.



                 Name (Please Print):   _________________________________________


                 Signature:   ________________________________________________
                Date:   ____________________________________________________




                  Youth Participation Parental Permission Form

For Youth

My commitment to the American Red Cross -                                       Yes       No

•   I will follow the rules and regulations of the American Red Cross.

•   I will respect all Red Cross clients as well as paid and volunteer staff.


•   The Red Cross will be able to count on me.


•   I will work as part of a team and cooperate with others.

•   When I need training, I will take it.

•   I will expect to learn from others.

•   I will help others learn from me.


•   If there are problems, I will work to resolve them.

•   If things aren’t going great, I will try to help make them better.

•   If I am at a Red Cross event or representing the Red Cross, I will
    not be on my cell phone or texting

•   If I can’t attend a meeting or finish an assignment, I will call the
    person in charge to let him/her know.

•   I will represent the American Red Cross in a way that will make
    the Westchester County Chapter proud.


_________________________________________
                  Date


_________________________________________                 ______________________________________
           Printed Name of Youth                                     Signature of Youth
For Parent/Guardian

Your son/daughter has expressed interest in volunteering for the Westchester County Chapter of the
American Red Cross. As we like to involve the parents/guardians of youth volunteers in the activities
their child will assume, we ask that you complete this form and return it to the chapter as soon as
possible. Then we can place your child in a volunteer position that will utilize and expand on their
current skills while benefiting the daily operation and mission of the American Red Cross. The
permission that you grant below will allow your child to participate in the following areas:



                            •   Community Outreach – Club Red Youth Council
                            •   Blood Services/Volunteer Office
                            •   Health & Safety Services
                            •   Youth Services - Special Events




I, the undersigned, certify that I have read this permission form up to this point, and I grant
permission for my child to volunteer with the Westchester County Chapter of the American Red
Cross. I also understand that I may contact the Volunteer Director at the Westchester County
Chapter during business hours - Monday through Friday, 8:30 a.m. to 4:30 p.m. - to discuss any
questions I may have regarding the nature of my child’s volunteer activities.



_________________________________________
                  Date


_________________________________________               ______________________________________
        Printed Name Parent/Guardian                           Signature of Parent/Guardian




                      Thank you for your support and dedication to the
                        American Red Cross in Westchester County!
                                  INFORMATION RELEASE
I give to the American Red Cross, its designees, agents and assigns, unlimited permission to use, publish
and republish in any form or media, information about me and reproductions of my likeness (photographic
or otherwise) and my voice, with or without identification of me by name.

If this form is signed both by person photographed, recorded, and/or interviewed and by parent/guardian,
it will be assumed that any photographs and/or recordings taken thereafter can be used as public
relations and communications materials for the American Red Cross in Westchester County. The American
Red Cross in Westchester County may reproduce said photographs, video, and/or comments via our
website (www.weschestercounty.redcross.org) and/or social networking websites, including, but not
limited to, Facebook and Twitter.

If you do not want specific photographs, recordings, and/or interviews to be made public after signing this
release, please inform the American Red Cross of Westchester County of said information, including the
information of the event, your name, and your signature.

                                 I agree to the aforementioned terms.

                                 I decline the aforementioned terms.

Name of person photographed, recorded or interviewed                    Age (if minor)
(Please print)


Street address, city, state and ZIP code



Email                                               Phone Number


Signature                                                               Date


Consent of Parent or Legal Guardian if above individual is a minor.

I consent and agree, individually and as parent or legal guardian of the minor named above, to the
foregoing terms and provisions.
Signature                                                               Date


Printed Name                                                            Relationship