Wallingford COMMUNITY Senior Center Under 18 Volunteer Application
Date: ______
Basic Information
Name: Date of Birth: ______
Address: City/State: ______Zip: ______
Telephone # 1: _____ Telephone # 2: ______
Email address: _____ Do you prefer to communicate via phone or email? ______
Please fill out the Parental Permission Form and turn in prior to first assignment. The form can be obtained by emailing the Volunteer Coordinator at , or by visiting WCSC.
Do you have any health restrictions, limitations or equipment that needs to be accommodated? £ Yes £ No
If yes, please describe: ______
Emergency Contact Information
Name: Relation: ______Telephone:______
Is your volunteer service court appointed? £ Yes £ No
Is your volunteer service due to community service or service learning? £ Yes £ No
Which positions or areas are you interested in volunteering?
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How many hours per week do you see yourself potentially volunteering? ______
During which times might you be available to volunteer?
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£ Weekday mornings £ Weekday afternoons £ Occasional weekday evenings £ Occasional weekend days
What type of commitment are you looking for (i.e., one event, a short project, a longer project, ongoing, etc.)?
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Are you a student and/or employed? £ Student £ Employed
Why do you want to volunteer at Wallingford Community Senior Center and what do you hope to gain from your experience?
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What skills and abilities would you like to use when volunteering at WCSC?
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Have you had previous volunteer experience(s)? If yes, please describe below. £ Yes £ No.
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Have you worked with older adults in a volunteer capacity? If yes, please describe. £ Yes £ No.
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How did you hear about Wallingford Community Senior Center?
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Please give the names and phone numbers for 2 references not related to you (One personal and one volunteer reference if available, or two personal if no volunteer experience).
Name/Relationship: ______Phone Number: ______
Name/Relationship: ______Phone Number: ______
Have you ever been convicted of a felony, sexually related crime, or an offense related to abuse of a child or a vulnerable adult? £ Yes £ No
If yes, please describe the nature of the offense, the date, and jurisdiction where it occurred.
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Signature: ______Date:______
Background Check
As part of volunteer screening, WCSC conducts background and reference checks prior to accepting volunteers for service. No background check is required for those under the age of 18 unless the position is long-term and the volunteer will be: (1) unsupervised with a client; (2) working with money, financial transactions, or WCSC financial records; or (3) working with confidential information of individuals, or works with WCSC's confidential records. By signing below, I voluntarily and knowingly allow WCSC to run background checks and reference checks as needed, and I waive the option to bringany legal action against Wallingford Community and Senior Center regarding the process and completion of a background check. I have reviewed my application and I attest that the information is true, accurate and complete to the best of my knowledge.
Signature: ______Date:______
Please email your completed application & Washington State Patrol WATCH background check (if applicable) to ,or mail it to Volunteer Coordinator, Wallingford Community Senior Center, 4649 Sunnyside Ave. N., Suite 140, Seattle, WA 98103. Please read the "Background Check" section of the application to see if you must fill out a background check.
Thank you for completing this volunteer application. We look forward to talking with you.
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Office Use Only
Interview and other notes
£ Background Check
£ Tour and Orientation
£ Assigned to Role
£ Entered in Database
£ Volunteer File Created
£ Background Check Waived by Executive Director
£ Parental Permission Slip Signed
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