VOLUNTEER APPLICATION

First Name:    Last Name:  

Address Line1:     
 Line2:      
 City:  State:   Zip: 

I am:  

Home Phone:   Work Phone:  
Cell Phone:   Email:   

Emergency Contact:  Name:  Phone:   Relationship: 


Taxi Team & Student Residence volunteers are required to have a current, valid, Driver's License.

License #:   State: 

You must be 18 years old and have a current valid driver's license to join these two groups.  
The Foundation checks license status.



AREAS OF INTEREST (Check all that apply)

   Hanging Flyers   Toy/Towel Drive        Weekend Student Residence
      
   Hospitality Volunteer        Office   Sewing Club
      
   Special Event   Fundraising   Kennel Volunteer   Speaker's Bureau



GENERAL AVAILABILITY 
Please list hours available as of today.
 



REFERENCES
Please provide at least 2 personal references, not related to you.
If someone referred you, please fill in name.

Reference 1
Name   Phone   Address  

Reference 2  
Name:    Phone:   Address:   

Referred to us by

Name:   Phone Address 



How did you learn about us? 

 


 

HOBBIES, SPECIAL SKILLS, OR TALENTS
Please let us know if you have special interests or talents you would like to share with the Foundation:



I affirm that the information provided in this application is true to the best of my knowledge.

Signature (Type full name):
 Date:


The Guide Dog Foundation for the Blind, Inc., does not discriminate on the basis of sex, age, race, color, national and ethnic origin, disability, religion or marital status in the administration of its educational policies, admission policies, employment, volunteer and other administered programs.

 

_________________________________________________________________________________________________________________________________________________________________________________________________



VOLUNTEER PUBLICITY RELEASE



I grant permission to the Guide Dog Foundation for the Blind Inc., its agents and employees, and to any person, company or organization that the Foundation may designate or authorize, to take photographs or videos of me during my volunteer activities as part of the Guide Dog Foundation program.


This consent includes the use of such photographs or films with or without my name or biographical data concerning me by the Foundation or another party on its behalf, without limitation as to time or frequency of use, for any or all of the following purposes:


1.Release to media, including newspapers and television

2.Educational or instructional purposes

3.Publicity or fund raising

4.Guide Dog Foundation publications, presentations, and related uses


I understand that the Guide Dog Foundation will try to notify me prior to using photos or videos of me, and I understand that such notification is not always possible.


Signature (Type full name):
 Date: