Please complete this application form if you are interested in becoming an Easter Seals DuPage & Fox Valley volunteer. Once you complete the form, click the submit button at the bottom.


Name and address

Please provide us with your name and current address



Demographic Information

Please provide us with the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers. Also, provide us with the name of two references.



Emergency First Aid Information

All information will be kept confidential and given only to medical personnel if necessary. Please provide the name of two emergency contacts.



Legal Information


Experience with Children


Your Volunteer Experience


Availability

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



Clubs, Organizations and Communities of Faith


School Information


Special Skills


Applicants Statement

In volunteering to participate in this activity, I agree that this activity is and shall be at my own risk against all casualties to myself or my properties, and that I take all risk of every kind, no matter how caused, and I hereby release and discharge Easter Seals DuPage & Fox Valley, its local affiliates, and my associated service clubs, participating dealers and sponsors, and indemnify them of and from all actions, claims and demands of every nature and kind whatsoever which I or my heirs, executors, administrators or assigns may now or can at any time hereafter have against the said persons or property while so participating in this activity whether any such loss, damage, or injuries which may be cause by negligence, default or misconduct of the sponsor of this activity, themselves, servants, agents, or members or otherwise whomever. If I become a volunteer, I understand that false or misleading information given in my application or interviews may result in discharge. Also, I understand that I am required to abide by all of the requirements of the program, policies, and procedures of Easter Seals DuPage & Fox Valley. Additionally, I hereby consent that any narratives, depictions, pictures, photographs, film, audio-visual or sound recordings, or testimonials of me made by Easter Seals DuPage & Fox Valley or its respective employees and agents may be used by Easter Seals DuPage & Fox Valley, and those acting with its permission, for the purpose of illustration, broadcast, or testimonial in connection with any work of Easter Seals DuPage & Fox Valley and that these materials may be released to the general public. I assign Easter Seals DuPage & Fox Valley all of my rights to these materials.