Online Volunteer Application

Thank you for your interest in serving as a volunteer with Wood Lane. Please complete this volunteer application, the information you provide will be considered confidential. All volunteers must have completed standard admittance procedures and be at least 16 years of age. If under 18, volunteer must complete and return Form 03-ALL-ALL-0044 before volunteering.

SECTION #1

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Birthdate *

SECTION #2

Placement Preferences

List your interests, activities, and special skills

Do you have a car?

Yes

No

SECTION #3

School

Major

Year in School

Instructor

Course Name/Number

Instructor

Number of hours hours required

SECTION #4

IN CASE OF EMERGENCY, NOTIFY:

First Name *

Last Name *

Relationship *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

SECTION #5

I certify that the facts in this application are true and accurate to the best of my knowledge and I authorize investigation of all statements contained herein and contact with the references listed above to provide Wood Lane with all appropriate information. I understand I may be transported in Wood County Board of DD-owned vehicles to and from activities in the course of my volunteer work. I also understand it is my responsibility to inform the Volunteer Coordinator of any changes in information which I have provided on this application.

Wood Lane may use my name during National Volunteer Week for recognition purposes *

Yes

No

Signature *

clear

Date *