Name

First Name

Last Name

Telephone Number

(###)

###

####

Today’s Date

MM

DD

YYYY

Age Group

Under 16-18

18-25

25-40

Over 40

Please select the area you wish to volunteer in

The Village Youth R.O.A.D.E.  

Community Engagement  

Special Events        

Administration Support   

University Placement Student

College Placement Student

Do you have the capacity to work remotely i.e., a private space, personal PC so confidentiality and privacy policies can be respected?

Yes

No

When are you available to volunteer? 

Weekdays Mon-Friday 9-5pm

 Weekday Evenings Mon-Friday 6pm-10pm

Weekends Sat/Sun

Do you have any special needs you would like to share with us?

Medical Alert

Anaphylactic Allergy

Hours sign off sheet

Supervision meetings if a placement student

References

Please provide two (non-relatives or friends) references i.e., Teachers, Supervisory for employment or volunteer roles, coaches, spiritual advisors i.e., Clergy. By providing these names you are acknowledging that you have spoken to your references and they have agreed to take part and that you are consenting to us contacting them in regards to providing a reference for position here at J.A.G. Village

First Name

Last Name

Phone

(###)

###

####

Reference 2

First Name

Last Name

Phone

(###)

###

####