VOLUNTEER!

Revived Fitness Volunteer Program

Ways to get involved with your community!

You can make a difference!

Make an impact today!

YOUTH VOLUNTEER PROGRAM APPLICATION

Name

First Name

Last Name

Date

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthdate

MM

DD

YYYY

Grade:

Email Address

Phone

(###)

###

####

School you attend:

T-Shirt Size:

Other Volunteer Or Work Experience:

Please Write In The Times You Are Available To Volunteer:

Are there any medical, physical or emotional circumstances that might limit or influence your volunteer service (please be specific and honest):

Please list one of your teachers/program advisors as a reference(Name and Phone):

IN CASE OF EMERGENCY, PLEASE NOTIFY THIS PERSON (Name and Phone):

List any medical limitations we should be aware of (please be specific and honest):

MEDICAL AUTHORIZATION: I authorize Revived Fitness LLC to obtain emergency transportation and any medical treatment necessary for my son or daughter in the event of injury or illness. I understand and agree to the above terms and agree to allow my son or daughter to participate in the Revived Fitness volunteer program.

Agree

Disagree

Parent or Guardian Name

First Name

Last Name

Date

MM

DD

YYYY

Parent or Guardian Phone

(###)

###

####

Parent or Guardian’s Signature and Date:

Youth Volunteer’s Signature and Date:

ADULT APPLICATION TO VOLUNTEER

Name

First Name

Last Name

Date

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Birthdate

MM

DD

YYYY

Current Occupation:

School or Employer:

Education Background:

Highest Grade Completed

College:

Degree Received

Do you have transportation:

Drivers License # and Expiration Date:

Skills and Interests:

Please list work and volunteer experience as well as any skills or interests that could be of use to the volunteer program

Please list type of volunteer work that would be of interest to you:

Is there anything that might limit your volunteer work:

Availability:

Please indicate times you are available to volunteer

Have you ever been convicted of a misdemeanor or felony (other than minor/civil traffic offenses), placed on probation, fined or given a suspended sentence (include military trial convictions)? Note: Reckless operation, hit-and-run, driving under the influence, excessive speeding, and similar charges are not considered minor traffic offenses.

Yes

No

If "yes," give details, including charges, dates, locations, etc.:

Convictions will not automatically bar an applicant from volunteering. The relationship of the conviction to the volunteer job, as well as its severity and the passage of time will all be considered.

References: List two personal references other than family members

Reference 1

First Name

Last Name

Phone

(###)

###

####

Reference 2

First Name

Last Name

Phone

(###)

###

####

In case of an emergency, please contact:

First Name

Last Name

Phone

(###)

###

####

Signature and Date: