Volunteer Application (Under 55)

2. 

4. This enrollment application is for volunteers under age 55. Please complete all sections. If you are 55 or over please use the Retired & Senior Volunteer Program (RSVP) Application.

6. First Name*
7. Last Name*
8. Preferred / Nickname
10. Street Address
12. Address Line 2
14. City
15. State
16. Zip Code
18. Phone*
19. Cell Phone
21. Email
22. Date of Birth
    Date of Birth
26. Physical / Medical Limitations
28. Employment Experience
30. Special Skills / Interests / Languages
32. Volunteer Experience (Current, Past, Preferred)
34. Preferred Volunteer Program(s) you have interest in assisting with (if known)
36. Emergency Contact - First Name
37. Last Name
38. Relationship
39. Phone Number
43. Morning Availability

    1. Monday Morning
    2. Tuesday Morning
    3. Wednesday Morning
    4. Thursday Morning
    5. Friday Morning
    6. Saturday Morning
    7. Sunday Morning
44. Afternoon Availability

    1. Monday Afternoon
    2. Tuesday Afternoon
    3. Wednesday Afternoon
    4. Thursday Afternoon
    5. Friday Afternoon
    6. Saturday Afternoon
    7. Sunday Afternoon
46. More Info

    Please feel free to provide any additional information that might help us learn more about you, so that we can match you to the best volunteer opportunity.

48. The following demographic information is optional.

50. Gender

    1. Male
    2. Female
    3. Nonbinary
51. Race
52. Ethnicity

    1. Hispanic
    2. Non-Hispanic
54. Marital Status

    1. Single
    2. Married
    3. Divorced
    4. Widowed
55. Military

    1. Active
    2. Veteran
    3. None
56. Are any of your family members actively serving in the military?

    1. Yes
    2. No
60. Volunteer Agreement

    By checking "I Agree", I acknowledge that I have read and understand the following statements:

    Please note: Some of our programs require a background screening to be completed at no cost to you, such as our Home Delivered Meals program and Companion programs. If you have interest in either of these, you will be required to fill out an additional form for the program, and cannot begin until successful results have been received.

    I understand that in the case of an accident/injury to my person or property, my personal insurance carrier will be considered the primary insurance coverage. New Hanover County insurance coverage will be secondary and used only to cover expenses not covered with the primary insurance carrier.

62. Volunteer Agreement*

    1. I agree
64. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
66. Electronic Signature*
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field