Please complete this application form if you are interested in becoming a Courage Kenny Rehabilitation Institute volunteer. A valid email address is required to complete this application and will be used as a communication tool in the application process. Email addresses are kept confidential and are not shared. All items with an asterisk(*) are required fields. Once you complete the form, click the continue button at the bottom.


Thank you!


Please note if you are under 18, your parent/guardian will need to sign at the bottom of this application.


CONTACT INFORMATION

*If you only use your cell phone, please put that number in the home phone field as well.



DEMOGRAPHIC INFORMATION

This information is used in aggregate data for demographic purposes only.



EMERGENCY CONTACT


PLEASE COMPLETE THE FOLLOWING REQUIRED QUESTIONS:


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REFERENCES

Please provide one personal and one professional reference, each with an email address (No family members). Reference request forms will be emailed to all references listed.



INTERESTS AND AVAILABILITY

Volunteers are asked to make a minimum commitment of 3 months or 30 hours. Please indicate the days and times you are usually available to volunteer.


Please click on the Assignment Preference hyperlink to see more information about each volunteer position.



SIGNATURE

Evidence of immunity is a requirement for certain volunteer roles at Courage Kenny Rehabilitation Institute. Once your application is received, you may need to complete and submit a health assessment form.


Failure to fully and truthfully complete this application may result in denial of volunteer opportunity or termination from the service. Courage Kenny is not obligated to provide placement, more are you obligated to accept the position offered.


Please type your name below to verify you agree with these statements and all of the information provided is accurate.


If you are a minor, please have your parent/guardian sign as well.