Volunteer Application

ADMINISTRATIVE OFFICES: 544 E Providence Ave. Spokane, WA 99207 www.bgcspokanecounty.org 509.489.0741 NAME ADDRESS CITY STATE PHONE (Home) PHONE
(Cell)

ZIP

E-MAIL D.O.B

S.S.

# NOTE: Providing the following information is strictly voluntary and confidential. It allows us to better assess our community outreach and will not be used in any manner to make decisions or judgments regarding a prospective volunteer.

GENDER

Female

Male

RACE/ETHNICITY

Have you ever been arrested? No Yes Asian/Pacific Islander South Asian Have you ever been convicted of a crime? Middle Eastern/North African Black, non-Hispanic No Yes Hispanic/Latino White, non-Hispanic Are there any outstanding warrants against you? No Native American Mixed-Ethnicity Yes Other _________________________________________ Are you currently taking prescription medicine? No Yes Please list any mental or physical disability that would affect your ability to serve as a volunteer in any capacity or special accommodations in our program:

EMERGENCY CONTACT INFORMATION

NAME PHONE

At which location would you like to volunteer?

Northtown Clubhouse
544 E. Providence Ave Spokane, WA 99207 (509)489-0741 School Year Volunteer Orientations: 1st & 3rd Tuesday of the month 5:00-6:00 pm

Lisa Stiles-Gyllenhammer Clubhouse

12509 N. Market St. Mead, WA 99201 (509)368-9175 School Year Volunteer Orientations: 1st & 3rd Thursday of the month 5:00-6:00 pm

BE GREAT Clubhouse
2900 1st Ave Spokane, WA 99202 (509)536-8152 School Year Volunteer Orientations: 1st & 3rd Wednesday of the month 5:00-6:00 pm

PLEASE BRING THIS APPLICATION WITH YOU TO ONE OF THE VOLUNTEER ORIENTATIONS LISTED ABOVE
*Call Clubhouse prior to orientation to confirm scheduled date and time

COMMITMENT Long-term (minimum 1 year) Short-term (3-4 months) No No Yes Yes

Boys & Girls Clubs of Spokane County program quarterly, which quarter will you be available to volunteer?

Winter

Spring

Summer

Fall

Volunteer Application
Please fill in the days and times that you are able to volunteer and the best time to schedule an interview. NOTE: Limited volunteer opportunities exist before 3:00 and after 7:00pm. Club closed on weekends. Start Date:________________________________________ Days Available MONDAY TUESDA

WEDNESD AY

THURSDA Y

FRIDAY

Y
Volunteer Times Available Interview Times Available 10-noon OR 1-2 pm

Total Hours Needed

What area(s) of programming interest you most?

Education & Career Development The Arts Sports, Fitness & Recreation Music/Performing Arts Technology & Computers Teen Programs BE GREAT: Graduate BE GREAT: Eat Great Health & Life Skills

List any special skills, areas of knowledge and/or experience (including non-English languages):

List any previous volunteer experiences (include name of organization) or experience working with youth:

Are you a College/University No Yes Name of Student? School Are you volunteering as part of a Service-Learning course/program? If yes, please provide the following: Instructors Name Instructors Phone # and email Course Title Are you volunteering as part of a corporate/community program or organization?

No

Yes

No

Yes

If yes, please provide the name of the program/ organization. Other______________________________________________________________________________________________________

How did you learn about the Boys & Girls Clubs of Spokane County?

Volunteer Application
Are you a former member of a Boys & Girls Club?
and location of the Club?)

No

Yes

(If yes, what was the name

NAME
LOCATION This form grants the Boys & Girls Clubs of Spokane County permission the information above to the local police departments and other appropriate agencies for a background check. The background check results will be released to the Boys & Girls Clubs of Spokane County to curb our parents concerns about adult supervision of the children in our programs and satisfy liability insurance requirements. All prospective volunteers are asked to complete this form, regardless of sex, race, color, creed or social status.

APPLICANT SIGNATURE FOR OFFICE USE ONLY Background check passed Volunteer Number No Yes Date Entered in Visions Staff Initials

DATE