Volunteer Application
Thank you for your interest in volunteering with Associated Community Talents, Inc.
We welcome volunteers as partners in creating a stronger community and providing programs and services to residents throughout the area
First*
Last*
Birthday*
/
/
MM
DD
YYYY
Address*
Apartment Number*
City*
State*
Zip Code*
Home Phone Number*
(Please Include Area Code)
Cell Number
(Optional)
Email Address*
Emergency Contact's Name
Emergency Contact's Phone Numbers
Home Phone Number*
(Please Include Area Code)
Cell Number*
Work Number
Are you volunteering for school service hours or the Delaware Volunteer Credit?*
Current School*
Grade*
Where would you like to volunteer? (check all that apply)*
List any special training, skills or interests you have:*
What goals do you have or skills would you like to gain from this volunteer Work?* assignment?
Is there anything else you want A.C.T. Inc. to know?*
Terms and Conditions
* Required
By applying, I agree to appear for a brief interview to finalize application. A signature of the Applicant is needed to finalize the application. If Applicant is under 18 a parent or Guardian is needed to accompany the Applicant for his/her signature of approval.
Please Note:
Applicant
If selected as volunteer, I will attend any required orientation session(s). I understand that A.C.T., Inc. volunteers shall not be entitled to any compensation, health or life insurance or any other employee benefits. Permission is also given to
A.C.T. Inc. to use any photographs or video (which includes my image for promotional purposes) without expectation of compensation.
Parent/Guardian
By signing, the Parent/Guardian of the minor volunteer hereby authorizes any necessary medical treatment for any Injury or illness which the minor may suffer while volunteering with A.C.T., Inc. It is understood that, time permitting, specific permission of the Parent/Guardian will be secured in the event any major medical treatment or surgery is to be undertaken, but should the need arise, this authorization and consent will cover such an event. In addition the above signed Parent/Guardian or Volunteer releases and agrees to hold harmless A.C.T., Inc. their agents, volunteers and employees from any and all claims whatsoever which may arise out of the performance of volunteer service. Permission Is also given to A.C.T., Inc. to use any image of the minor volunteer for promotional purposes without expectation of compensation.
Name
First*
Last*
Emergency Information
Age Group*
owned and operated by
Associated Community Talents, Inc.
45 W Main Street Middletown Delaware
a non-profit corporation
