VOLUNTEER INTAKE SHEET

Name: Check here if you are a High School student.

Address: Contact Phone: ( ) -
City/State/i!: "mail:
References (Other than family)
Name: Name:
#elationshi!: #elationshi!:
Phone Num$er: ( ) - Phone Num$er: ( ) -
Address: Address:
City/State/i!: City/State/i!:
SKILLS (Check all that aly)!
%eaching/%utoring/Child Su!er&ision: S!ecial "&ents/ 'undraising
Preschool (arketing/ Pu$lic #elations
)rades *-+ ,anguage(s) S!oken:
High School -outh ,anguage(s) %ranslation:
Clerical (.ata "ntry/ 'iling/ etc.) %echnology (0e$/ Com!uter Skills/ etc.)
"n&ironmental Ser&ices (%ree Planting/ )raffiti #emo&al/ Street Clean-u!s/ etc.)
S!eciali1ed Skills:
CERTI"ICATIONS!
CP#/'irst Aid (Check those that apply: 2nfant Child Adult)
Proof of Clearance: %3 'inger!rinting (required for any volunteer hours with youth)
4ther certifications:
AVAILA#ILIT$! (Please indicate s!ecific times and days you 5ould like to &olunteer. %lease n&te that K$CC
re'(ires ) *eeks t& r&cess all +&l(nteers,)
Are you &olunteering to fulfill a ser&ice commitment6 -es No
2f yes/ ho5 many hours do you need to fulfill6 $y / / (mm/dd/yy).
Ho5 many hours you 5ould like to &olunteer6 !er 5eek/ !er month/ !er year
Hours A&aila$le: (Pro&ide e7act dates if kno5n)
(onday %uesday 0ednesday %hursday 'riday Saturday Sunday
Not a&aila$le
C"#%2'2CA%24N and A8%H4#2A%24N ("&rm cann&t -e r&cesse. *ith&(t a si/nat(re,)
2 certify that the information !ro&ided in the 9olunteer 2ntake Sheet is true/ correct and com!lete. 2 authori1e &erification of all statements contained in this 2ntake
Sheet. 2 authori1e former em!loyers and/or educational institutions to !ro&ide information concerning me/ and 2 release them from lia$ility for !ro&iding any such
information to the *oreato5n -outh : Community Center.
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Signature .ate
H#sak
#e& <==+>==?
FOR OFFICE USE ONL!
#ecei&ed on: ;;;;;;;;;;;;;;;;;;;;;; $y: ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
8nit(s): ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
2nter&ie5: ;;;;;;;;;;;;;;;;;;;;;;;;; #ef @>: ;;;;;;;;;; #ef @<: ;;;;;;;;;
Please return 9olunteer 2ntake 'orm to: 'AA to: "-mail to:
*-CC/ Attn: Ashley *im/ ?B<B 0. Cth St./ Ste. ?== D ,os Angeles/ CA E==<= (<>?) E<B-==>B &olunteerFkyccla.org