Online Volunteer Registration Form

Personal

Name (Required)

Your E-Mail Address (Required)

Address (Required)

Street, City, State, ZIP Code

Primary Phone (Required)

Secondary Phone (Required)

Date of Birth

-- 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 / -- January February March April May June July August September October November December / -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Gender (Required)

Female
Male

Emergency Contact (Required)

Who would you like us to notify in case of an emergency? Please include their name, relationship, address and phone number.

Demographics (optional)

Race

(optional)

Not Specified White Black Hispanic Asian/Pacific Islander American Indian/Alaskan Native

Marital Status

Not Specified Married Widowed Single Divorced

Military Service (optional)

Veteran

Yes
No

Branch of Service

Which War?

Transportation

Walk (Required)

Do you wish to work within walking distance?

Yes
Not Required

Drive (Required)

Will you drive to and from your assignment?

Yes
No
Maybe

Reimbursed (Required)

Do you need to be reimbursed for mileage?

Yes
No

License (Required)

State and Drivers License Number. (RSVP Accident and Liability Insurance requires a valid drivers license and liability insurance to be in effect)

Insurance (Required)

What company provides your Auto Insurance coverage?

Volunteering

Occupation (Required)

What is/was your primary occupation?

Company Name

Languages

List any foreign languages you may speak.

Conditions

List any conditions (physical or other) which may limit your assignment

Prior Registration

Have you registered with RSVP before? When?

How did you learn about RSVP?

Reference

Who (if anyone) referred you to RSVP?

Current Volunteering

Are you currently volunteering anywhere? What is you job and title?

Volunteer Interests (Required)

Select any types of volunteer duties in which you are interested.

Services to Youth

School Volunteer

Drug/Alcohol Abuse

Food Distribution

Crime Prevention

Literacy/Libraries

Office Work

Driving

Senior Programs

Arts and Crafts

Hospice

Environment, Parks

Support Groups

Committees

Homeland Defense

One Time Projects

Handyman Project

Business Development

Mental Health Programs

Computers/ Data Entry

Animal Care/Animal Shelters

Nursing Homes/Assisted Living Facilities

Community Information/Betterment

Hospitals/Health Delivery

Aid to Needy, Disaster Relief

Museums, Art, Music, Theater

Services to the Disabled

Advisory Councils/Board of Directors

Skills

Describe any skills, training, talents or hobbies you have you feel would be helpful in your volunteer work. Include areas of expertise or special interests.

Prior Volunteering

What other volunteer activities you have been involved in?

Comments

Comments

Have anything else that we should know about your, or need to clarify the above information? Let us know here.