VOLUNTEER FWC APPLICATION FORM
Volunteers provide essential services to many of KCS's Projects and we welcome your interest in helping our organization. For insurance purposes, KCS is required to collect information regarding yourself. Please fill out the form below and submit to our Corporate Secretary. This will be forwarded to the Director and Executive Director for approval. After that, we will contact you and let you know the results of your application.
FULL NAME: ___________________________________________
HOME PHONE #: ( ) ____________
CELL/PAGER #: ( ) ___________________________
E-MAIL: __________________________________
CURRENT ADDRESS: ____________________________________________________________________
GENDER: ___Male ___Female
AGE: ______
ETHNICITY: _________________________________
AVAILABILITY:
MONDAYTIME:_________ AM/PM
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
SERVICES TO BE PROVIDED (Please check attached form of Volunteer Opportunities): __________________________________________________________________________________________
REFERENCES: 1. Name: ____________________________ Phone: _________________
Relationship: __________________
2. Name: ____________________________ Phone: _________________
Relationship: __________________
PROFESSIONAL LICENSE (S):
Yes____, please specify:
_______________ No____
AUTO LICENSE/INSURANCE: Yes____ No____
THIS IS TO CERTIFY THAT I DESIRE TO VOLUNTEER MY SERVICES AND ACKNOWLEDGE THAT I WILL NOT BE COMPENSATED FOR THESE SERVICES.
______________________________
VOLUNTEER APPLICANT'S SIGNATURE
DATE: _________
FORM#C 12/12/02
VOLUNTEER OPPORTUNITIES
2003
Volunteer's Name: _________________________ Date: __________
PLEASE PUT A CHECK MARK ON THE FOLLOWING VOLUNTEER OPPORTUNITIES YOU ARE INTERESTED IN:
Information Dissemination:
Writing articles for the media
Updating the website
Designing handouts and brochures
Developing the bi-annual newsletter
Organizing the library
Creating a scrapbook of media articles
Fund Raising:
Developing an annual calendar campaign
Referral and Screening:
Taking blood pressure, check blood glucose (Nurse; Nurse aide)
Making referrals and doing follow-ups
Data collection and analysis
Youth/Parent/Senior Programs:
Assisting in organizing/implementing intensive workshops for you, parents and seniors
Planning and implementing intergenerational activities i.e. basketball tournaments, talent shows and proms
Community Workshops:
Planning cultural workshops for health providers
Planning health/social workshops for the public
Nutrition/Fitness Activities:
Teaching line and ballroom dancing
Leading aerobics
Leading walkathons
Conducting food/chef demonstrations
Teaching nutrition/physical activity in high schools (StayFit Project)
Building Acquisition and Maintenance:
Doing janitorial service
Other area(s) of interest
(please specify): ________________________________________
FORM#C2 12/12/02