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Volunteer Form

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Are you volunteering as part of a group?
If yes, fill in the name of the group. If volunteering individually, put N/A.

Purpose of Volunteering

Fill out areas that apply.

Community Volunteer - Other categories below not applicable.
College Student-Course Requirement
Corporation Volunteer
Community Service Hours/Court Mandated
Community Service Hours/TANF

Availabilty
List the times you are available to volunteer each day.
Example: 3:30 - 5:30

Interests
Tell us in which areas you are interested in volunteering:
Age Group Preference
Tell us which age group you would prefer to work with. We will try and place you with this preference as much as possible.

For Statistical purposes only, please provide the following information:

Gender
Race

Additional Background Check Information

The information contained in this application is correct to the best of my knowledge. I hereby authorize Don Moyer Boys & Girls Club and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to the following areas: verification of social security number; current and previous residences; and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records. I further authorize any individual, company, firm, corporation, or public agency to divulge any and all information, verbal or written, pertaining to me, to Don Moyer Boys & Girls Club or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.

Don Moyer Boys & Girls Club and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicants personal information, including, but not limited to, addresses, social security numbers, and dates of birth.

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The last part of our background check form are 2 PDF forms that needs to filled out. These forms require a HANDWRITTEN signature on each and is required to volunteer with the Don Moyer Boys and Girls Club. Please download this form, fill it out and return it by email, fax, or drop it off at the Club.

Your volunteer application will not be processed until this form has been received. 

If you have any questions or problems filling out this form, please contact the club.

Our Impact

  • Youth Served

    1712

  • Volunteers

    860

  • Teens Served

    616

© 2017 Don Moyer Boys & Girls Club
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