Your Name*:

Email*:

Your Birthday*:

Address:

City:

State:

Zip:

Phone*:

Other Phone:

YesNo May we call you at work?*

Work Phone:

What hours/days of the week can we contact you?*

Work Experience:

Position:

Responsibilities:

Date:

Position:

Responsibilities:

Date:

Current level of education:

Life Experience (interests, abilities, skills, and/or hobbies):

Volunteer Experience (in your faith community, neighborhood, regular service, etc.):

Organization:

Brief description of role:

Organization:

Brief description of role:

Worship Affiliation (if any):

What would you like to gain from your time with CRI?

Personal References (name, address, phone number, or other information of a contact not related to you):

Consent, General Release, and Indemnity Agreement: We, the undersigned, hereby make application to Community Renewal International, Inc. (CRI) for the volunteer named above to participate in CRI programs. In consideration of permission for the volunteer to participate in this activity(ies), the undersigned hereby release, discharge, exonerate, and absolve CRI, its staff, Board, volunteers, representatives, agents, and successors from any and all responsibility and/or claims, and causes of action of any types whatsoever arising out of or in any way connected with participation in activities and programs. We agree to indemnify each of them and hold harmless from all obligations, liabilities, claims, demands, costs, expenses, which may rise out of or be connected, directly or indirectly, with said minor's participation in said activity(ies).

The undersigned warrant that the applicant has never been convicted of a crime and hereby warrant that the applicant has not demonstrated any disciplinary problems or other behavior which would reflect upon or cast doubt upon their ability to adhere to and abide by the Rules and Expectations (see section above).

YesNo* I am willing to work with children or youth and I have fully read and understood the Rules and Expectations involved.

Agree*
I solemnly swear, to the best of my knowledge and belief that the information presented in this application is true and complete and that I know of no impediment that would render me unfit to work with children or youth (if working with children or youth). I will keep confidential any information I learn about individuals or families in the course of my volunteer work.

Agree*
I give permission to CRI to use photographs or videos of me obtained while participating in events or activities.

Agree*
I hereby release, discharge, exonerate and absolve CRI, its staff, Board, volunteers, representatives, agents and successors from any and all responsibility and/or claims, and causes of action of any types whatsoever arising out of or in any way connected with participation in activities or programs.

Initials Here*:

Enter the code displayed:*

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Your Name*:

Your Parent/Legal Guardian*:

Email*:

Parent/Guardian's Email*:

Your Birthday*:

Address:

City:

State:

Zip:

Phone*:

Other Phone:

YesNo May we call you at work?*

Work Phone:

What hours/days of the week can we contact you?*

Transportation for Volunteer*:
Parent/guardian will provideDesignated other adult will provideVolunteer will provideOther or designated adult

Medical Insurance Information:

Personal Physician*:

Phone*:

Office Address:

Insurance Company*:

Policy Holder*:

Agent/Contact:

Policy Number*:

YesNo Any special medical needs, like allergies, disabilities, or other conditions of which adult supervisors should be aware?*

If yes, please explain.

Emergency contacts:

Name*:

Relationship:

Phone*:

Name*:

Relationship:

Phone*:

Work Experience:

Position:

Responsibilities:

Date:

Position:

Responsibilities:

Date:

Current level of education (grade or equivalent):

Life Experience (interests, abilities, skills, and/or hobbies):

Volunteer Experience (at school, in your faith community, in your neighborhood, etc.):

Organization:

Brief description of role:

Organization:

Brief description of role:

Worship Affiliation (if any):

What would you like to gain from your time with CRI?

Personal References (name, address, phone number, or other information of a contact not related to you):

For Parent/Legal Guardian: In case of medical emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give my permission to the physician selected by an adult agency representative in charge to secure proper treatment.

Parent/Legal Guardian Consent, General Release, and Indemnity Agreement: We, the undersigned, hereby make application to Community Renewal International, Inc. (CRI) for the minor named above to participate in CRI programs. In consideration of permission for the minor to participate in this activity(ies), the undersigned hereby release, discharge, exonerate, and absolve CRI, its staff, Board, volunteers, representatives, agents, and successors from any and all responsibility and/or claims, and causes of action of any types whatsoever arising out of or in any way connected with participation in activities and programs. We agree to indemnify each of them and hold harmless from all obligations, liabilities, claims, demands, costs, expenses, which may rise out of or be connected, directly or indirectly, with said minor's participation in said activity(ies).

The undersigned parent(s)/legal guardian(s) warrant that the applicant has never been convicted of a crime and hereby warrant that the applicant has not demonstrated any disciplinary problems or other behavior which would reflect upon or cast doubt upon their ability to adhere to and abide by the Rules and Expectations (see section above).

YesNo* I am willing to work with children or youth and I have fully read and understood the Rules and Expectations involved.

Agree*
I solemnly swear, to the best of my knowledge and belief that the information presented in this application is true and complete and that I know of no impediment that would render me unfit to work with children or youth (if working with children or youth). I will keep confidential any information I learn about individuals or families in the course of my volunteer work.

Agree*
I give permission to CRI to use photographs or videos of me obtained while participating in events or activities.

Agree*
I hereby release, discharge, exonerate and absolve CRI, its staff, Board, volunteers, representatives, agents and successors from any and all responsibility and/or claims, and causes of action of any types whatsoever arising out of or in any way connected with participation in activities or programs.

Parent/Guardian's Initials Here*:

Enter the code displayed:*

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