| ADULT VOLUNTEER APPLICATION | |||||||||
| Neighborhood
Boys & Girls Club 2501 W. Irving Park Road Chicago, IL 60618 |
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| First Name | ________________________ | Last Name | ___________________________ | ||||||
| Address | ________________________ | Apt #_________ | Zip________________ | ||||||
| Daytime # | ________________________ | Evening # | __________________________ | ||||||
| ________________________ | Pager/Cell # | __________________________ | |||||||
| Occupation | ________________________ | Company____________________________ | |||||||
| Do you have children enrolled at NBGC? (please list names and ages) | |||||||||
| ________________________________________________________________________ | |||||||||
| ________________________________________________________________________ | |||||||||
| Have you volunteered at NBGC in the past? If yes, please list activities or programs | |||||||||
| ________________________________________________________________________ | |||||||||
| ________________________________________________________________________ | |||||||||
| How did you hear about the Neighborhood Boys & Girls Club? | |||||||||
| ________________________________________________________________________ | |||||||||
| ________________________________________________________________________ | |||||||||
| What program (s) are you interested in volunteering for now? | |||||||||
| ________________________________________________________________________ | |||||||||
| ________________________________________________________________________ | |||||||||
| Which groups do you prefer to work with? Please check all that apply. | |||||||||
| Co-Ed Programs | Boys Programs | Girls Programs | Team Sports | ||||||
| ___ | Pre-Discovery | ___ | Cadet League | ___ | Pebble League | ___Boys Football | |||
| Infant-5 Yrs | 2nd-3th Grade | 2nd-3th Grade | |||||||
| ___Boys Basketball | |||||||||
| ___ | Discovery | ___ | Prep League | ___ | Junior League | ||||
| K-1st Grade | 4th-5th Grade | 4th-5th Grade | ___Boys Floor Hockey | ||||||
| ___ | Cadet/Pebble | ___ | Tribe League | ___ | Senior League | ___Boys Baseball | |||
| 2nd-3th Grade | 6th-8th Grade | 6th-8th Grade | |||||||
| ___Boys Teen 16" Softball | |||||||||
| ___ | Prep/Junior | ||||||||
| 4th-5th Grade | ___Girls Soccer | ||||||||
| ___ | Tribe/Senior | ___ | Boys Programs | ___ | Girls Programs | ___Girls Basketball | |||
| 6th-8th Grade | Where Needed | Where Needed | |||||||
| ___Girls 12" Softball | |||||||||
| ___ | Teen | ||||||||
| 9th-12th Grade | ___Girls Cheerleading | ||||||||
| Would you be interested in starting a new program? If yes, list your ideas | |||||||||
| ________________________________________________________________________ | |||||||||
| ________________________________________________________________________ | |||||||||
| ________________________________________________________________________ | |||||||||
| Do you have any special skills, talents or areas of interest? Please list | |||||||||
| ________________________________________________________________________ | |||||||||
| ________________________________________________________________________ | |||||||||
| ________________________________________________________________________ | |||||||||
| Please list your volunteer experience | |||||||||
| Agency Name | Dates Involved | Duties/Responsibilities | |||||||
| ______________________ | _____________________ | ______________________________________ | |||||||
| ______________________ | _____________________ | ______________________________________ | |||||||
| ______________________ | _____________________ | ______________________________________ | |||||||
| ______________________ | _____________________ | ______________________________________ | |||||||
| What days & times are you available to volunteer? Please check all that apply | |||||||||
| Day of week | 9:00-12:00 | 12:00-3:00 | 3:00-6:00 | 6:00-9:00 | |||||
| Monday | ________ | ________ | ________ | ________ | |||||
| Tuesday | ________ | ________ | ________ | ________ | |||||
| Wednesday | ________ | ________ | ________ | ________ | |||||
| Thursday | ________ | ________ | ________ | ________ | |||||
| Friday | ________ | ________ | ________ | ________ | |||||
| Saturday | ________ | ________ | ________ | ________ | |||||
| ________ | |||||||||
| Please list two non-family personal references. | |||||||||
| Name | Relationship | Phone | |||||||
| ___________________ | _________________ | _________________ | |||||||
| ___________________ | _________________ | _________________ | |||||||
| Signature_______________________________ | Date___________________ | ||||||||