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Volunteer Application
(fields marked with * are required)
General Information
First Name
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Last Name
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Phone
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Email
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Street Address
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City
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State
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Zip Code
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Your emergency contact's information:
First Name
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Last Name
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Phone
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Relationship to You
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Street Address
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City
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State
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Zip Code
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Education
Please indicate the highest level of education you have achieved so far:
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-- None --
1 Year of High School
2 Years of High School
3 Years of High School
High School Diploma
Some College
Associates Degree
Bachelors Degree
Masters Degree
Doctorate(PhD or equilvalent) Degree
High school you attended or are attending:
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If applicable, college you attended or are attending:
If applicable, your college major or majors:
Experience
Please list any work or volunteer experience with any individuals with special needs or in the area of recreation. Include: place worked, length of time, age and type of disability of participants, supervisor’s name and phone number.
Volunteering Interests and Skills
Why do you want to volunteer with NEDSRA?
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Please indicate any 3 hour segments (beginning time noted) that you would be available to volunteer:
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Monday Morning 9:00am
Monday Afternoon 12:00pm
Monday Evening 6:00pm
Tuesday Morning 9:00am
Tuesday Afternoon 12:00pm
Tuesday Evening 6:00pm
Wednesday Morning 9:00am
Wednesday Afternoon 12:00pm
Wednesday Evening 6:00pm
Thursday Morning 9:00am
Thursday Afternoon 12:00pm
Thursday Evening 6:00pm
Friday Morning 9:00am
Friday Afternoon 12:00pm
Friday Evening 6:00pm
Saturday Morning 9:00am
Saturday Afternoon 12:00pm
Saturday Evening 6:00pm
Sunday Morning 9:00am
Sunday Afternoon 12:00pm
Sunday Evening 6:00pm
Please indicate any types of classes/areas you would like to assist with:
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Team Sports
Social Clubs
Arts & Crafts
Swimming
Nature Programs
After-school Programs
Preschool Programs
General Programs for All
We provide types of programs to meet the need of differently abled people. Please indicate if you prefer to work in one or more of the following program areas:
Intellectual Disability or Autism
Physical Disability or Visual Impairment
Adaptive Sports
Special Olympics
Please indicate which age groups you prefer to work with:
Youth
Adult
If you have valid/current certifications or licenses in these areas, please indicate:
Water Safety Instructor Certification
Personal Training Certification
CPR Certification
Lifesaving Certification
Language Interpreting Skills
Adaptive Aquatics Certification
Commercial Drivers License
First Aid Certification
Other Certifications
If you speak other languages (besides English), please indicate which ones here:
Spanish
Polish
ASL
Russian
Hindi/Urdu
Mandarin
Arabic
Bengali
Japanese
French (Canadian)
German
Other
How did you hear about NEDSRA?
*
-- None --
Referral from Friend
Ad on Web
Ad on TV or Radio
Facebook
Twitter
Searched online (Google)
Disclaimer
I am over 16 years of age. I hereby assume complete responsibility for any injury or damage sustained by the applicant and release Northeast DuPage Special Recreation Association of any and all liability for such injury or damage occurring during volunteer work for Northeast DuPage Special Recreation Association.
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