VOLUNTEER APPLICATION

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The Club depends on the generosity of our volunteers, partners, supporters and investors. Each is vital to the organization's continued ability to save the lives of at-risk kids

Boys & Girls Clubs of Rochester, Inc. 500 Genesee Street Rochester, NY 14611 | tel: 585-328-3077 ext.103 fax: 585-328-5863 | Contact Us

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Middle Name:
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E-mail:
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Alternate Phone:
Social Security Number:	- -
Date of Birth:	/ /
Valid Driver's License	Yes No Driver's License #
How did you hear about the Boys & Girls Club of Rochester?
Days Available
Time(s) Available
Start Date	Calendar
End Date	Calendar
Have you ever worked/volunteered for the Boys & Girls Clubs?	Yes No If yes, please give dates and reason for leaving:
Position(s) Desired:	Homework Assistance/Tutoring/Literacy Computer Lab Gamesroom/Field Trips Gym/Sports Other If other, please explain:
Preferred Age Group:	6-9 years old 10-12 13-15 16-18
Have you ever been convicted of a felony:	Yes No If no, please explain:
Would you be willing to submit to a drug test?	Yes No If no, please explain:
Highest level of education completed:
Any additional information/talents, etc., that may be of interest to the club:

Please list three persons not related to you.
Reference One
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Reference Two
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Reference Three
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Address:
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Phone:
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VOLUNTEER APPLICATION

Reference One

Reference Two

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