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H O R I Z O N S at HARLEY
2011 Adult Volunteer Application Form
· Summer Program Volunteers are needed between Weeks 2 and 6 of the program.
· Although we try very hard to fulfill your assignment selection it may be necessary to assign you to the area where you are most needed.
· Your signature confirms you have read and signed the Volunteer Code of Conduct Form.
· If 18 years old or older a background check will be necessary.
Date ___________
Name __________________ Signature ________________________________
Address ___________________________________________________________________________
Street City/Town Zip Code
Telephone ____________________________ E-mail ______________________________________
Home Cell
Which volunteer opportunities are you interested in? (check all that apply)
___ Assist during the summer program
___ Fund-raising and/or assist with special events
___ Clerical support for the Director’s office
___ New program initiatives during the school year
When do you want to volunteer? ___Summer ___Regular School Year ___Either/both
Please check any statements that help to describe your availability or interest
___ During the school year, I am usually available ___M ___Tu ___W ___Th ___F
___ During the school year, I am seldom available the same day every week.
___ During the summer, I would prefer to volunteer full days.
___ During the summer, I would prefer to work ___ AM ___PM only.
Which grade level(s) would you prefer? ___k __1st __2nd __3rd __4th __5th __6th __7th __8th
I would prefer working ___ one-on-one ___ with small groups
I would like to help in the area(s) of ___ Reading __Writing ___Math ___Recreation
___Science __Art ___Music ___Other:___________
What special interests, hobbies or talents do you have?
If this is your first year as a Horizons volunteer, please list an individual we may contact for a reference:
_______________________________________________________________________________
Name Relationship Telephone
If you are applying to volunteer in Summer 2011, please check the week(s) you are available:
__July 5-8(Wk.2) __July 11-15(Wk.3) __July 18-22(Wk.4) __July 25-29(Wk.5) __August 1-5(Wk.6) (dates are tentative, subject to change)
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