Kids Count Volunteer Application
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1. Name (First, Middle, and Last) *
2. Date of Birth *
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3. What are your pronouns? *
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4. Sex *
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5. Mailing Address (Please include full address) *
7. Phone # *
8. Email *
9. Emergency Contact (Name, Phone #) *
10. Have you ever been convicted, found guilty, entered a plea of nolo contendere (no contest), entered a deferred prosecution, or pre-trial intervention agreement, or had adjudication withheld in a criminal offense other than a mild traffic violation (DUI is not a minor traffic violation)? Are there any criminal charges now pending against you? Seal or expunged records must be reported pursuant to S 943.0585 F.S. *
If you answered "yes" to question 10: When was the date of arrest
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If you answered "yes" to question 10: County and City where you were arrested
If you answered "yes" to question 10: Nature of Charge(s)
If you answered "yes" to question 10: Disposition
By typing your name below, you are agreeing to abide by the policies and procedures of Kids Count in Alachua County, Inc, Volunteer Program. You are also agreeing to the program's right to not place you or discontinue use of your services as a volunteer. *
Site Preference *
Volunteer Availability

Kids Count offers volunteer opportunities Monday - Friday from ~2:00pm - 5:00pm 

Please select all days you may be available to volunteer. Your availability and schedule will be confirmed with your program director.  *
Required
Are you volunteering for service learning hours/class credit? *
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