Volunteer Application Form

Please complete this application form if you are interested in becoming a Community Partnership of the Ozarks volunteer. Once you complete the form, click the Continue button at the bottom.

Name and address

First name:

Last name:

Title:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip:

Home or Cell phone:

OK to call me here

Email address:

Demographic Information

We'd appreciate the following information; it will help us choose appropriate placements and make volunteer staffing decisions.

Date of birth:

Age:

Education:

T-Shirt size:

Do you have a background check completed within the last 12 months available, either directly or through another local agency? Yes or No

Availability

Please indicate the days and times you are usually available to volunteer.

Emergency Contact

First name:

Last name:

Home phone:

OK to call here

Cell phone:

OK to call here

Relationship:

Which hospital do you prefer?

Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

Media Release

I grant CPO permission to use any photographs/video taken of me while I'm volunteering at CPO, in conjunction with the publicity of their programs/organization.

Please enter Yes to consent to media sharing or No to refuse media sharing.

By signing below, you are finalizing your volunteer application, releasing CPO from all liability including injury or damages sustained by any volunteer while participating in any CPO supported/sponsored event or activity, and acknowledging that you understand that all contact with the media whether print, television, radio, online or other shall be handled by CPO staff only. You agree that unless you are asked by CPO to be part of a story or feature, you are not permitted to talk, with or contact the media as a representative of CPO. You understand that failure to comply with this policy may result in dismissal as a CPO volunteer.

I Agree