Volunteer Application Your InformationName* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Have you lived outside of Texas in the last 7 years?*NoYesPlease provide that address (if you lived outside of Texas):Gender Male Female Phone*Good time to reach you by phone:Email Address* Emergency Contact Name* First Last Emergency Contact Phone*Check all that apply: I speak Spanish. I know Sign Language. I have transportation. Where did you hear about volunteering for The Arc of the Capital Area? National Charity League - Cap Tex National Charity League - North Austin Junior League of Austin Volunteer Match All for Good My school My company Presentation A friend A special event Young Men's Service League Other What other source did you hear about us from?Name of Child Who Will Be Volunteering with You*Employer*Does your employer provide funds for volunteer hours?YesNoNot sureVolunteer Experience1) Place, Date and Type of Work2) Place, Date and Type of WorkHave you ever worked with adults or children with disabilities?* Yes No If yes, briefly describe your experience:Have you ever volunteered with The Arc of the Capital Area in the past?* Yes No Please provide the year:2017201620152014201220112010 or earlierIn what areas are you interested in volunteering?*Currently volunteering in the art studio is our greatest need. The Art Studio I am interested in volunteering for bowling*just one timecontinuouslyI am interested in volunteering in the art studio*just one timecontinuouslyWhen would you like to volunteer with the art studio?* Art studio full-day shift: 9:00am-2:00pm Art studio morning shift: 9:00am-11:30am Art studio afternoon shift: 12:00pm-2:00pm Which days are you available to volunteer with the art studio?* Monday Tuesday Wednesday Thursday Friday For how long would you like to volunteer?Please note: Volunteering with the art studio requires at least a 3-month commitment One Year 6 months 3 months Please list any skills, hobbies, abilities or interests that you would like to utilize in your volunteer experiences.For Student Volunteers OnlyAre you volunteering for class credit? Yes No SchoolNumber of Hours NeededPlease Note: Volunteering with the art studio requires at least a 3-month commitment.Course NameInstructor NameInstructor Email Criminal BackgroundHave you ever been convicted of a crime?*YesNoCrime details - If yes, please explain.*List any previously used names:Criminal Background Check Authorization/Waiver/Indemnity/Confidentiality/Media Consent*I hereby give permission for The Arc to obtain information relating to my criminal history record. The criminal history record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudications. I understand that this information will be used, in part, to determine my eligibility for a volunteer position with this organization. I also understand that as long as I remain a volunteer here, the criminal history records check may be repeated at any time. I understand that I will have an opportunity to review the criminal history and a procedure is available for clarification, if I dispute the record as received. I, the undersigned, do for myself, my heirs, executors and administrator, hereby remise, release and forever discharge and agree to indemnify The Arc of the Capital Area, a service of United Way/Capital Area and each of their officers, directors, employees and agents harmless from and against any and all causes of actions, suits, liabilities, cost, debts and sums of money, claims and demands whatsoever, and any and all related expenses resulting from the investigation of my background in connection with my application to become a volunteer. I understand that any information released to me about any Arc of the Capital Area client is strictly confidential. I agree to keep this information confidential. I understand that The Arc of the Capital Area adheres to a tobacco free policy in all facilities where volunteer activities take place. I agree to not use tobacco products while volunteering or when on the premises. I hereby grant permission for The Arc of the Capital Area to use my name, likeness, written and spoken comments in informational, promotional, development, and fundraising materials to promote quality programs and community awareness for persons with disabilities. Yes, I have read these statements and agree. Parent/Guardian Name, if volunteer is under 18 First Last If the volunteer is under the age of 18, please indicate the name of the parent or guardian.