Volunteer Application - The Arc of the Capital Area

Your Information

Name*

First Middle Last

List any previously used names:

Address*

Street Address Address Line 2 City State ZIP Code

Please 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?

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?

Volunteer Experience

1) Place, Date and Type of Work

2) Place, Date and Type of Work

Have 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:

In what areas are you interested in volunteering?*

When would you like to volunteer to be Car Runner/Safety Guard?

The Safety Guard will help ensure safety in our pick up/drop off area in front of our building. They will be provided a Walkie-Talkie and safety vest and will let staff know when a student's ride has arrived.

Morning shift, 8:30-9:30am, Monday-Friday
Afternoon shift, 1:30-2:30pm, Monday-Friday

I am interested in volunteering for bowling

just one time
continuously

I am interested in volunteering*

just one time
more than once

Which days are you available to volunteer?*

Which shifts are you available for?*

Full-day shift: 8:30am-2:30pm
Morning shift: 8:30am-11:30am
Afternoon shift: 11:30am-2:30pm

When would you like to volunteer in the Adult Education Program?

Adult Ed full-day shift: 8:30am-2:30pm
Adult Ed morning shift: 8:30am-11:30am
Adult Ed afternoon shift: 11:30am-2:30pm

Which days are you available to volunteer with the Adult Education Program?

For how long would you like to volunteer?

Please note: Volunteering with the art studio or the Adult Education Program requires a commitment of at least 4 months

One Year
Six Months
One Semester

Please list any skills, languages, hobbies, abilities, or interests that you would like to utilize in your volunteer experiences.

Are you volunteering for class credit?

Yes
No

School

Number of Hours Needed

Please Note: Volunteering with the art studio requires at least a 4-month commitment.

Course Name

Instructor Name

Instructor Email

Criminal Background

Have you ever been convicted of a crime?*

Crime details - If yes, please explain.*

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.

If volunteer is under 18, please list parent/guardian name

First Last

Guardian will need to be in attendance with the minor.