Adult Volunteer Application: Outreach

Date
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First Name
*

Last Name
*

Address 1
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Address 2

City
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State
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Date of Birth
*

Social Security #
*

If you are over 18 and involved with YEWTHS ROC we must run a background check.

Citizenship
*

Marital Status
*

Occupation
*

T-Shirt Size
*

Why do you want to go on this outreach?
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Do you have any foreign language skills? What language(s)?
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What other skills do you have that might be utilized on this outreach?
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Have you ever been on an outreach/distribution before? Where? If so, what was your experience like?
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Do you know of any reason that you may have difficuly functioning in a foreign country?
*

Have you ever been convicted of a felony?
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This information is solely for the ROC Wheels, Inc. staff

MEDICAL INFORMATION

Do you have any dietary restrictions?
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Yes

Please explain.

Is there any medical or physical reason why you would have to restrict yourself from strenuous activity?
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Do you have any allergies to food, medicine, or the environment?
*

EMERGENCY CONTACT

Name
*

Phone
*

E-mail
*

Relationship
*

REFERENCE

Please give the name of someone (non-relative) you know for a personal reference.
*

Phone
*

Address 1

Address 2

City
*

State
*

BIOGRAPHY

Please write a short biography below. The biography will be used to share with other volunteer team members as an introduction prior to the beginning of the project.
*

Please sign the application by typing your full name in the box below.
*