Volunteer Application - Freeport Community Services

Date*

Birthday*

Full Name*

First

Last

Mailing Address

Street Address City State Postal / Zip Code

Phone (Home)*

Phone (Mobile)

Work Phone

Email address

Emergency contact name and number:*

Availability

Volunteer start date*

Skills: Please list relevant skills, work experience, interests and/or volunteer service.

Languages spoken other than English:

Do you require any physical accommodations that should be considered when selecting a volunteer assignment? *

Yes

No

If yes, please explain:

Please list two non-family references:

Name of Reference*

First

Last

Relationship:*

Phone number

Email*

Name of Reference(2)*

First

Last

Relationship:(2)*

Phone number(2)

Email(2)*

Have you been convicted of any crimes not annulled or expunged by a court?*

Yes

No

If yes, please explain

Contact:
Susan Adams
Volunteer Coordinator
(207) 865-3985 x206

I attest that the above information is true to the best of my knowledge.*

Note: If you are under 18, please download and print this form. A parent/guardian signature is required (not digital signature).