Personal Information

Name	First
	Last
Address	No. & Street
	City
	State
	Zip
Home Number
E-Mail (Required)

Emergency Contact

Name
Relationship
Phone Number

Current Employment

Current Employer
Position
Address

Education

High School	Year/Level Completed
College or University	Year/Level Completed
Special Training (Business, Vocational, ect.)	Year/Level Completed

Are you presently attending school?

Yes   No

 

Will you be receiving academic credit for your volunteer work?

 

Yes   No

Are there any factors that would prevent you from doing certain types of work?

Yes   No

                            If yes, Please explain

Have you served as a volunteer before?

Yes   No

                             If yes, specify when and where

Volunteer Supervisor
Phone Number

                             May we call your volunteer supervisor for a reference?

                                Yes   No

References

Please fill out the reference information completely.  We would like someone that you have worked for and/or has known you for a long time.

Availability for volunteering?

Day Evening Weekend  Regularly Scheduled Occasionally/On Call

Interpersonal Communications Building and Grounds Office Services Marketing/Public Relations Social Service Skills (Other) Other:

In-House Volunteer-works a minimum of twice a month

Auxiliary Volunteer -  is available for special needs and events

Junior Volunteer - Ages 15 to 18 can be unsupervised (under 15 must have a     parent accompany them)

We utilize in house volunteers 7 days a week, 8:00am to 11:00pm.  We highly recommend 3-hour shifts.

Monday Tuesday Wednesday Thursday Friday Saturday Sunday    Time:

By submitting this form I give the Ronald McDonald House permission to check the references I have submitted.  If I am between the ages of 15 and 18 I also authorize the Ronald McDonald House to obtain further permission to volunteer from my parent or guardian.