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Minor Release Form 2023
This form is to be completed by the volunteer and parent of any volunteers under the age of 18. Teen Volunteers must be at least 16 years old.
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* Indicates required question
Minors First Name
*
Your answer
Minors Last Name
*
Your answer
Minors Current Address( street name, city, state, and zipcode)
*
Your answer
Email Address
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Please list any allergies or dietary restrictions. If none type N/A
*
Your answer
Parent Information
First Name
*
Your answer
Last Name
*
Your answer
Current Address( street name, city, state, and zipcode)
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Alternative Phone Number
*
Your answer
Volunteering experience
Have you volunteered/worked with individuals with special needs before?
*
Yes
No
If yes, please tell us more (when, where, and how long did you volunteer/work?)
Your answer
References
Please list two references below. These references need to be non-family members
Refence #1
Full Name
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Relationship to you
*
Your answer
Refence #2
Full Name
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Relationship to you
*
Your answer
Program/Activity Skills
Please tell us what your interests include. Select all that apply.
Arts and Crafts
*
Drawing
Painting
Sculpting
None
Other:
Required
Recreational Activities
*
Sports
Fitness
Archery
Zumba
None
Other:
Outdoor Activities
*
Swimming
Hiking
None
Other:
Required
Do you have any of the following certifications?
*
CPR
Frist Aid
Food Handlers
Sign Language
None
Other:
Required
If there is anything else you would like us to know, type it below.
Your answer
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