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Eva's Heroes Volunteer Information & Background Check Form
Thank you for your interest in volunteering with Eva's Heroes.
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* Indicates required question
Email
*
Your email
Basic Information
First Name
*
Your answer
Middle Name
Your answer
Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Phone Number
*
Your answer
Current Address (street name, city, state, and zipcode)
*
Your answer
Addresses in the last 5 years (street name, city, state, and zipcode)
*
Your answer
Please list any allergies or dietary restrictions. If none type N/A
*
Your answer
Volunteer Experience
Have you volunteered/worked with individuals with special needs before?
*
Yes
No
If yes, when, where, and how long did you volunteer/work?
Your answer
References
Please provide two references. These references need to be non-family members.
Reference #1
Full Name
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Relationship to you
*
Your answer
Reference #2
Full Name
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Relationship to you
*
Your answer
Program/Activity Skills
Select all that apply.
Arts and Crafts
*
Drawing
Painting
Sculpting
None
Other:
Required
Fine Arts
*
Singing
Acting
Dancing
Playing an Instrument
None
Other:
Required
Recreational Activities
*
Sports
Fitness
Archery
Zumba
None
Other:
Required
Outdoor Activities
Swimming
Hiking
None
Other:
Certifications
*
CPR
First Aid
Food Handler License
Sign Language
RN/LPN
Behavior Management
None
Other:
Required
Is there anything else you would like us to know?
Your answer
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