CES Volunteer Application Contact Information Name Address City, State, Zip Primary Phone Alternate Phone Email Organizational / Congregational Affiliation Availability & Skills Age 18 or above? Yes No » If you are under 18, please call Melanie LaPointe at 612-870-1125 x128 to sign up. What days are you available to volunteer? Monday Tuesday Wednesday Thursday Friday When can you begin volunteering? Professional Skills Car | Driver Information The following information helps us run a responsible program. Do you have a valid driver's license? Yes No Do you have a reliable vehicle to use for meal delivery? Yes No Does the vehicle meet minimum state insurance requirements? Yes No Have you had any moving traffic violations within the past 5 years? Yes No If you've had moving violations, please explain. NEXT PAGE Other Volunteer Information Do you have any health considerations we should be aware of? Why do you want to volunteer with CES? Please list two references [ Name | Relationship | Phone Number ] How did you find out about our CES volunteer opportunity? I found you through: Faith-based org. bulletin (which?) Part of a faith-based team Part of an employee team (whose?) Senior Center Newspaper/Newsletter Friend/Family Member Other (please explain) Additions / Explanations Current Employer (or last employer) Previous Volunteer Experience (most recent first) Emergency Contacts Please list 1-2 persons that we have permission to contact in case of emergency. First Emergency Contact Name & Address (include city, state & Zip) Phone/Email Relationship Second Emergency Contact Name & Address (include city, state & Zip) Phone/Email Relationship PREVIOUS PAGE NEXT PAGE COMMUNITY EMERGENCY SERVICEGENERAL RELEASE WAIVER The undersigned volunteer has agreed to work as a volunteer for Community Emergency Service (CES). As a volunteer I understand that some of the activities performed by volunteers of CES involve a risk of injury, including the inherent risks associated with any warehouse activities. As a volunteer I hereby expressly release, relinquish, and forever discharge CES and their respective successors and representatives (collectively, the "Released Parties"), of and from any and all claims, which the undersigned may have against the Released Parties arising out of volunteer service for CES and any and all related activities. I also understand that CES will conduct a criminal background check on me prior to my involvement with CES. Additionally, as a volunteer, I hereby authorize CES to take photographs of myself, the volunteer, and to use or publish such photos (either still photos or film/video) as they see fit and I waive any rights and any claims I might have regarding the taking of publishing of any such photos. I have read this agreement. Signature of Volunteer* Today's Date PREVIOUS PAGE CANCEL SUBMIT Thank You! Thank you for submitting this application form and for your interest in volunteering with Community Emergency Service. We will be in contact with you soon about your participation in these activities. Please turn on javascript to submit your data. Thank you!