Complete and Submit this form online (below) or download and print this form (click here) and mail to:
Questions? E-mail email@example.com or Call (321) 209-2775.
Today's Date: (required)
Gender: (required) ---MaleFemale
Employed? (required) ---YesNo
Student? (required) ---YesNo
Your Email: (required)
Your Primary Phone: (required)
Your Secondary Phone:
In case of emergency, we have your permission to contact:
Please check below the days and times you are available and willing to volunteer.
Would you prefer: (required) ---A Regular AssignmentAn Occasional Assignment
Preferred contact method: by phoneby email
Volunteer Opportunities at Neighbors Network (check all areas of interest):
Gardening/Yard WorkChores (dust, vacuum, etc.)ErrandsTidy Kitchen AreaFriendly VisitsPrepare Meals in AdvanceHelp NN w/ Special EventsAssist w/ Pet CareMoving Furniture, Boxes, etc.NN Committee MemberFriendly Phone CallsHome Fix-It JobsOrganizing Garage, Closet, etc.Office Tasks for NNBasic Tech Support (Mac, PC)Walking BuddyReading to MembersSocial/Education ProgramsPlay Cards, Other GamesSort Photos, PapersOther (describe below)
Please confirm: (required)
I am physically and mentally able to perform each of the volunteer activities I have checked above.
Special skills/hobbies to share:
Are you willing to also participate as a volunteer driver? NoYes
*(Current FL driver’s license and proof of insurance required in addition to background check.)
Do you have any questions about driving? NoYes
(2 required and please, no relatives. We kindly request that you notify your references in advance to inform them about Neighbors Network and your interest in volunteering).
Reference #1: (required)
Name: Phone: Email:
Reference #2: (required)
Name: Phone: Email:
Adult (18+)Teen (age 14 to 17)Adult* w/ Child (type child's name below)Child* (type adult's name below)
Name of Child with Adult or Name of Accompanying Adult with Child:
*Any child under the age of 18 must have the accompanying signed form from a parent or legal guardian giving permission for the child/teen to be a volunteer and take responsibility for the child/teen to complete expected responsibilities.
Note: A parent or the organization coordinating the volunteers must provide children/teens with transportation to and from the volunteering site.
I agree to protect the confidentiality of all information pertaining to any Neighbors Network (NN) member, non-member or other volunteer associated with NN. My signature below acknowledges my agreement to adhere to this confidentiality policy.
I understand that NN will review this information and all other information required to complete my application and that my application does not obligate NN to offer me a volunteer assignment. I hereby grant permission to any individual, school representative, company or corporation to give NN any relevant information that may be required to arrive at a decision on the status of this application.
I release NN, its officers, employees, agents and representatives from any and all liability and /or damages incurred by me in accessing or using such information.
If accepted as a volunteer for Neighbors Network, I understand that I am an important ambassador for Neighbors Network within the community, and I will not make statements representing the organization unless I have permission to do so. I also understand that I may not sign any agreement involving contractual or financial obligations. I also agree to abide by guidelines for volunteer behavior and language as described in the Neighbors Network Volunteer Handbook.
I understand that a background check may be required, depending on the frequency and type of volunteering I may be performing; if required, I agree to participate in the organization’s background check process.
I give my permission to be photographed and videotaped and for these images to be used by Neighbors Network in its marketing materials in print and electronic media at the sole discretion of Neighbors Network.
Agreement: My signature acknowledges that I have read and agree to the information above and confirmed the accuracy of the information provided.
Signed: (use mouse or finger tip to sign in this space)