Volunteer Data Sheet

**Please note that due to insurance regulations, we cannot accept volunteers less than 14 years of age, Additionally, federal and insurance regulations restrict the type of work volunteers under18 years of age can perform.
Service Information (Please Print)
Volunteer Interests & Availability
Skills and Interests
The information provided below should be related to the project listed on the previous page.
List specific classes taken, degrees, licenses or certificates received that make you qualified for this project.
Please highlight relevant workplace, volunteer, or other experiences including hobbies
Which of the previous skills might you feel would apply to apply needs? Please explain.

Authorization and Agreement by Applicant

1. I certify that the facts outlined in this volunteer application are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation in this application or placement interview may result in the rejection of my application or discharge from the volunteer program.

2. I consent to have SRHS complete a criminal background check prior to volunteering.

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.