Volunteer Registration Form

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Date of Birth

Gender

Education

Talents/Skills

Are there any physical conditions we should be aware of that may require accommodation? (Select all that apply)

If other please specify:

How did you hear about us?

Do you have any experience working with the I/DD community or volunteering?

YesNo

If so, where?

Current Employer

Occupation

Does your employer have an Employee Volunteer Incentive Program?

YesNo

The following activities interest me (select all that apply):

What is your availability to volunteer? (select all that apply):

Preferred Location (select all that apply):

Why are you interested in volunteering at InCommunity?

Image Use Agreement: I agree I grant permission for the Released Parties to use my name, likeness, voice, relevant biographical information and any other indicia of my identity (collectively, "Publicity Rights") in publicity, advertising and promotions in all forms of media throughout the use of my image for marketing and communications purposes

YesNo

Please Initial (This will serve as your signature.)