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Volunteer Form
Select a Volunteer Position (*required)
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Sites (*required)
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First Name (*required)
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Middle Initial (*required)
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Last Name (*required)
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Date of Birth (if under 18 you must submit the paper version
   of this form to include your parents approval) (*required)
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Address
Street Address (*required)
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City (*required)
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State (*required)
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Zipcode (*required)
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Main Phone Number xxx-xxx-xxxx (*required)
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Best time to reach you at this number (*required)
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Second Phone Number xxx-xxx-xxxx
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Best time to reach you at this number (*required)
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Email Address (*required)
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EMERGENCY CONTACT INFORMATION
Contact Name (*required)
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Relationship To You (*required)
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Contact Phone Number xxx-xxx-xxxx (*required)
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CONVICTIONS OR FELONIES
Have you been convicted of or plead guilty to a felony or any criminal offense? (*required)
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If you selected Yes to the Convictions/Felony Question please describe in full:
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STUDENT VOLUNTEERS
Are you looking to fulfill a school requirement or will you receive school credit for your service?
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If Yes, please provide the Name of Your School:
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Is this a Service-Learning experience?
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Number of Hours needed:
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Deadline to complete hours:
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COMMUNITY SERVICE VOLUNTEERS
Are you looking to complete Are you looking to complete High School or College Community Service Hours?
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IF YES:
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Number of hours needed:
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Deadline to complete hours:
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School/University
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Phone:
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Have you previously volunteered for a youth organization
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Have you previously volunteered for other organizations:
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If yes, list the Organization name and describe Your Duties:
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Current/most recent employer:
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Location
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Position
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How long have you been employed here?
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Current/most recently attended school:
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Location of School you attended
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Current year in school/highest level completed
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Date completed (or graduation date)
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Certifications held (include date of expiration):
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REFERENCES
For the safety of our participants, staff and volunteers, we complete at least 2 reference checks on every program volunteer. References may include supervisors, co-workers, faith leaders, teachers or school counselors. Please do not list relatives/ household members.
1. Name of Reference (*required)
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Relationship To You (*required)
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Reference Phone Number xxx-xxx-xxxx (*required)
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Email Address (*required)
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2. Name of Reference (*required)
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Relationship To You (*required)
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Reference Phone Number xxx-xxx-xxxx (*required)
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Email Address (*required)
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3. Name of Reference
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Relationship To You
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Reference Phone Number xxx-xxx-xxxx
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Email Address
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Conditions of Volunteer Participation and Release from Liability

Read the following Conditions before submitting this form.

Background Certification: I certify that all of the information provided on this application is true and complete. I authorize the Cross-Country for Youth (CCFY) to investigate and verify any and all of the information I have submitted. Because the CCFY strives to provide a safe environment for children and youth, I understand that the CCFY may order a criminal history check, and I authorize this investigation.
Volunteer Terms: I agree to abide by the CCFY’s policies, procedures and Code of Conduct. I understand the CCFY does not provide any health benefits (i.e. medical, dental, workers compensation, etc.) or any accident insurance for me as a volunteer; I understand it is my responsibility to provide this coverage. I understand that the CCFY does not provide volunteer compensation or trade volunteer services for membership or program fees.
Property Loss: I understand the CCFY is not responsible for my personal property lost, damaged or stolen while participating in CCFY volunteer activities.
Medical Treatment: I give permission for CCFY representatives to provide or arrange for emergency care for me, and to arrange for transport to an emergency center for treatment. I consent to medical treatment deemed immediately necessary or advisable by a physician if I am unable to act on my own behalf. I further understand that the CCFY is not responsible for payment for such medical treatment.
Nondisclosure and Noncompetition: After expiration or termination of this agreement, volunteer agrees to respect the confidentiality of Cross-Country for Youth materials, and not to disclose them to anyone. The volunteer agrees not to compete with the CCFY in the practice of Cross-Country training and character development while volunteering for CCFY and for a period of 3 years after termination of the volunteer agreement.
Photograph Permission:I give permission for the CCFY to use, without limitation or obligation, photographs or other media that may include my image or voice to promote or interpret CCFY programs.
Release from Liability: I understand that accidents may occur during my volunteer activities. By signing below, I release the CCFY, its agents, directors, consultants, and employees from all liability based on any damage, loss or injury, whether it is the result of ordinary negligence or otherwise, caused to me or my dependent from participation as a volunteer.
Security Feature Security Feature
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By submitting this form, I acknowledge that I have read and agree to accept the terms and conditions as stated above.