Volunteer Application

Last Name:    First Name:    Middle Initial:

Home Address:

City:    State:    ZIP:

Over 18? Yes No    Birthday: (MM/DD)

Employer: Occupation:

Work Address:

City:    State:    ZIP:

Home Phone:    Work Phone:

Preferred E-mail Address:

Emergency Contact:

Contact:    Phone:

Relationship:

Education: Please select one (required)

Less than high school   High school or GED

Vo-tech or College (less than four years)

Four-year college degree or equivalent   Advanced degree

Membership/Organizations Volunteer Experience

Special Interests

Have you had experience with a seriously ill child? If yes, please explain.

How did you hear about Ronald McDonald House Charities?

What are your expectations from this volunteer experience?

What skills and interests would you like to share?

When are you available to volunteer? Select all that apply (required).

Weekdays   Evenings   Weekends

Other (please specify)  

References:
Please list three personal and/or professional references (not including relatives).

Reference 1

Last Name:    First Name:

Home Phone:    Work Phone:

Address:    City:    State:    ZIP:

Reference 2

Last Name:    First Name:

Home Phone:    Work Phone:

Address:    City:    State:    ZIP:

Reference 3

Last Name:    First Name:

Home Phone:    Work Phone:

Address:    City:    State:    ZIP:

Have you ever been convicted of a felony? If yes, please explain.

Signature:
Please type your name and today's date in the fields below (required).

I affirm that the information contained in this application is correct to the best of my knowledge. I understand that before beginning my volunteer service, I will be interviewed, submit to a reference check and attend an orientation/training session. If I am unable to fulfill my scheduled commitment, I will notify Ronald McDonald House Charities with as much notice as possible. I agree to serve a minimum of six months or 60 hours of service, with the first 90 days to be mutually probationary. I understand that this application does not guarantee a volunteer placement with Ronald McDonald House Charities and, if accepted, I will not receive payment for my service.

Name:    Date: (MM/DD/YYYY)

Photo Release Consent:
Please type your name in the two fields below and include today's date.

I, grant to Ronald McDonald House Charities the right and permission to use photographs of myself, motion pictures, recordings, or any other record of this interview for legitimate purpose of Ronald McDonald House Charities. I hereby release and discharge Ronald McDonald House Charities from any and all claims, actions, and demands arising out of or in connection with the use of any of the above, including, without limitation, and all claims for invasion of privacy and libel. I affirm that I am 18 years of age or older and have read and agree to the foregoing.

Name:    Date: (MM/DD/YYYY)