Boys and Girls Club Application


Volunteer Days Commitment: Preference is for each student to volunteer from 3:30 pm to 7:00 pm each day you volunteer in order for Boys & girls Club children to have some continuity of service, but we realize that may not be possible with your school schedule. Please fill in the dates and times you will commit to working with children in the afterschool program. (Fill in all dates and times that apply)


Monday (3:30 - 7pm)
Tuesday (3:30 - 7pm)
Wednesday (3:30 - 7pm)
Thursday (3:30 - 7pm)
Friday (3:30 - 7pm)
Date:
Time
Monday (3:30 - 7pm)
Tuesday (3:30 - 7pm)
Wednesday (3:30 - 7pm)
Thursday (3:30 - 7pm)
Friday (3:30 - 7pm)
Date:
Time

Please provide two references that can speak to your dependability & character (other than family or friends):

Reference 1:
Reference 2:
Volunteer Release I have not been convicted of any felony or misdemeanor classified as an offense against a person or family, of public indecency, or a violation involving a state of federally controlled substance.

I am not under current indictment.

I hereby fully release, discharge and hold harmless the Club, participating organizations and all of their employees, officers, directors, and coordinators from any and all liability, claims, causes of action, costs and expenses which may be or may at any time hereafter become attributable to my volunteerism at the Club.

I understand that the Club staff reserves the right to terminate a volunteer.

I understand that the program involves spending a minimum offive hours this semester at the Club.

I am not allowed to take the youth off the Club grounds.

Volunteering takes place only at the Club and does not encourage or approve of relationships established between volunteers/Boys and Girls Club members and family members beyond the organized and supervised activities of the program.

I will demonstrate self-respect and respect for others at the Club

I will not participate in any form of verbal or physical abuse at any time while serving at the Club.

I will not use, possess or distribute alcohol, drugs, tobacco, or weapons at any time while serving at the Club.

I understand that volunteers are expected to remain on duty for the full time agreed upon.

I understand that I cannot use a cell phone or take pictures of anyone at the Club while I am there.

I understand that volunteers who do not show up on the selected date and time without providing advance notice more than once will no longer be allowed to volunteer at the Club.

I give permission for program staff to conduct a criminal background check as part of the screening for entrance for volunteers. This includes verification of personal and employment references as well as a criminal check with the authorities.

Program staff has final right of acceptance of applicant as a volunteer and reserves the right to terminate a volunteer at any time.

I have read this Release Statement and agree to the contents. I certify that all statements in this application are true and accurate.


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