Volunteer Information

Name *

Email *

Phone

Address *

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Birthdate

Emergency Contact *

Emergency Phone *

Serving at NCC

What inspired you to explore volunteering at NCC? *

What experiences, interests, or skills would you like to bring to your volunteering at NCC? *

How many hours per week or month (please specify week or month)are you hoping to volunteer at NCC? *

Please list days/times that are best for you to volunteer at NCC. *

Are there any accessibility needs, health considerations, or personal boundaries you’d like us to be aware of as we help match you with volunteer opportunities? If so, please let us know what you need here. *

Personal Refrence

Reference Name *

Reference Phone Number *

Reference Email

Do you have court ordered community service hours requirements? *

Yes

By completing this form, I understand and agree that any misrepresentation I made in completing the application is sufficient cause for cancelling this application and/or separation from the NCC Volunteer Program. I give NCC the right to contact all references and to secure additional information about me from sources I have not listed. I hereby release NCC and its representatives from liability for seeking such information, and all other persons, corporations or organizations for furnishing such information. NCC does not discriminate in volunteer placement and no questions on this application are used for the purpose of limiting or excluding any applicant’s consideration for volunteer placement on a basis prohibited by local, state or federal law. This application is current for only 60 days. At the conclusion of 60 days, if I have not heard from NCC and still wish to be considered for volunteer placement, I understand that I must complete and submit a new application. I understand that just as I am free to resign at any time, NCC reserves the right to terminate my volunteer placement at any time, with or without cause and without prior notice. I understand that no representative of NCC has the authority to make an assurance contrarily. I hereby grant permission to any staff person to obtain medical care from a licensed physician, hospital or medical clinic for me in the event that I should become ill or injured. I hereby grant permission to NCC to use any and all photographs or videotape on websites or other materials produced by NCC. I hereby release all of the above stated entities and their agents from any and all liability in connection with providing information, investigating or evaluating my application. I waive any right that I may have to inspect any information provided about me in connection with this application. I read and understand the above stated information within this release and am confirming below of my own free will. *

I Acknowledge

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Volunteer Information

Serving at NCC

Personal Refrence