VOLUNTEER APPLICATION

First Name:   Last Name: 

Address Line1:    
 Line2:      
 City: State:  Zip:


I am: 

If under 18, please provide parent/guardian information:
Parent/Guardian Name:

Parent/Guardian Email: 

 

Home Phone:   Work Phone:  
Cell Phone:   Email:  

Emergency Contact:  Name: Phone:  Relationship: 

Taxi Team & Student Residence volunteers are required to have a current, valid, Driver's License.

License #:   State: 

You must be 18 years old and have a current valid driver's license to join these two groups.  
The Foundation checks license status.

AREAS OF INTEREST (Check all that apply)

   Hanging Flyers   Toy/Towel Drive        Taxi Volunteer
      
   Food Server    
   Office   Sewing Club
      
  Fundraising    Speaker's Bureau


GENERAL AVAILABILITY 
Please list hours available as of today.



REFERENCES
Please provide at least 2 personal references, not related to you.
If someone referred you, please fill in name.

Reference 1
Name:   Phone:   Address:  

Reference 2  
Name:   Phone:  Address:  

Referred to us by

Name:   Phone:  Address:  



How did you learn about us?

In a few words, please describe what motivates you to volunteer with us. What are your volunteer goals?


 

Please list your work experience, specialized skills, talents or hobbies related to the volunteer positions that you checked.


 

Are you an active duty member or veteran of the United States Armed Forces?   

Is any other member of your household an active duty member or veteran of the United States Armed Forces?  

I affirm that the information provided in this application is true to the best of my knowledge.

Signature (Type full name):Date:




The Guide Dog Foundation for the Blind, Inc., does not discriminate on the basis of sex, age, race, color, national and ethnic origin, disability, religion or marital status in the administration of its educational policies, admission policies, employment, volunteer and other administered programs.

 

_________________________________________________________________________________________________________________________________________________________________________________________________

Liability Release

 I understand that participation in the above event or activity could include actions or tasks that might be hazardous to the participant named above.

By signing below, I assume any risk of harm or injury which might occur to the participant due to my participation in the event or activity. I release the organization or business named above from all liability, costs and damages which might arise from participation in the above named event or activity.

If the participant is a minor, I agree that the minor has my consent to participate in the event. I further provide my consent for the organization or business named above to seek emergency treatment for the minor if necessary. I agree to accept financial responsibility for the costs related to this emergency treatment.

I understand there is a potential risk of injury, but represent my physical condition will allow me to participate. I agree to hold the organizations harmless from any claim resulting from injury to me and in no event to seek any form of speculative or punitive damages of any kind.

 

Publicity Release

I hereby give the Guide Dog Foundation and America’s VetDogs the unqualified right to reproduce any media – including film, photographic prints, audio, video, or digital files – with or without my name or biographical data concerning me by the Foundation or another party on its behalf, without limitation as to time or frequency of use, for any or all of the following purposes:

 

  1. Release to media, including print, broadcast, and electronic media (including social media platforms) now known or later developed
  2. Educational or instructional purposes
  3. Publicity, marketing, or fundraising
  4. Guide Dog Foundation and America’s VetDogs – the Veteran’s K-9 Corps® publications, presentations, and related uses

 

I understand that the Guide Dog Foundation or America’s VetDogs® will try to notify me prior to using any media, and I understand that such notification is not always possible.

I have read the above and foregoing and agree to all of the terms.


Signature (Type full name):Date: