Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Have you ever been convicted of a crime (felony or misdemeanor) other than a minor traffic violation? *

Yes

No

Would you like to join our general DSACT mailing list to receive our newsletter, event updates, and general DSACT communications? (You will still receive our volunteer newsletter if you opt out of the general mailing list) *

Yes

No

Skills and Experience *

In which areas do you feel you have moderate to excellent skill? Check all that apply.

Athletics or Coaching

Child Care

Creative Arts

Dance or Gymnastics

Photography or Videography

Tutoring or Teaching

Writing

Are you fluent in any of the following languages? *

Please select all that apply.

Chinese

French

Japanese

Spanish

N/A

Volunteer Agreement *

I agree to serve as a volunteer and commit to the following: 1. To perform my volunteer duties to the best of my ability. 2. To respect those we serve. 3. To meet time and duty commitment, or to provide adequate notices so that alternate arrangements can be made. 4. To maintain open communication with my supervisor and volunteer coordinator regarding any issues or concerns. 5. To adhere to rules and procedures, including confidentiality of agency and client information. I understand and agree that submitting this application form does not automatically register me as a DSACT volunteer, and that there may be certain qualifications I must meet before I may begin volunteering, including but not limited to the acceptance of established volunteer policies and procedures, and successful completion of a background check. I give DSACT permission to take photographs and/or video of me, and I grant DSACT full rights to use such photographs and/or video of me, and any reproductions or adaptations thereof, for fundraising, publicity or other purposes, including but not limited to the right to use them in printed and online publicity, social media, and press releases. Furthermore, I agree to release, defend, hold harmless and indemnify DSACT from any and all claims involving the use of my picture or likeness. I recognize and acknowledge that there are certain risks of physical injury to volunteers providing and/or engaging in volunteer activities, and I voluntarily agree to assume the risk of all injuries, death, damages, or loss, regardless of severity, that I may sustain as a result of such volunteer activities. I furthermore agree to waive and relinquish all claims I may have as a result of such volunteer activities against DSACT, or any of DSACT’s respective officers, employees, agents, and/or other volunteers, collectively or individually. By submitting this form, I attest that the information I have provided on the form is true and accurate to the best of my knowledge.

Yes