Volunteer Application Form

Please complete this application form if you are interested in becoming a Ability Connection volunteer. Once you complete the form, click the Continue button at the bottom.

If you have any questions, please reach out the the Volunteer and Community Outreach Manager directly at lcole@abilityconnection.org

Contact and General Information

First name:

Last name:

Middle name:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

OK to call me here

Cell phone:

Email address:

Date of birth:

Age:

Gender:

T-Shirt size:

Emergency Contact Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

1

2

First name:

Last name:

Home phone:

Cell phone:

Relationship:

Personal and Professional References

1

2

First name:

Last name:

Work phone:

Cell phone:

Email address:

Relationship:

Time Commitment and Availability

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

Additional Questions

Please let us know if you have any questions.

Volunteer Agreement

By checking 'I agree'

I certify that my answers are true and complete to the best of my knowledge.

I authorize investigation of all matters contained in this application or data pertinent to my volunteering.

I acknowledge that any false statements or misrepresentation on this application will be cause for refusal of placement or immediate dismissal.

I understand and agree that in the performance of voluntary services I am not an Ability Connection employee and shall have no rights to wages or benefits and no promise, expressed or implied, of consideration for future employment.

I agree to indemnify and hold Ability Connection, its employees and contractors, harmless from any and all liability for any injury that may be suffered arising out of or in any way connected with my participation in this program.

I also agree to grant full permission to Ability Connection to use my name an any photographs, videography, motion pictures, or recordings for any purpose whatsoever without any obligation, liability, or compensation to me.

I Agree