Our Kids NetworkEmbed Developmental assets into your organization

Asset Building Toolkit

Volunteer program

Sample strength-based volunteer application

VOLUNTEER APPLICATION FORM

Mission Statement: To provide a safe, supportive place where children and youth can experience new opportunities, overcome barriers, build positive relationships and develop confidence and skills for life.

Thank you for your interest in becoming a volunteer at the Boys and Girls Club of Kamloops. In order to offer a satisfactory volunteer experience, kindly complete the following application:

*Please note applicants must be 15 years of age to volunteer and those under 19 years of age require parental consent to complete the necessary Criminal Record Check*

______

Date (MM/DD/YY)

Age of client groups: (Please place an X next to your area(s) of interest)

0-36 months ___3-5 years ___5-12 years ___12 years & up___Families ___

______

Birth Date (MM/DD/YY) Name

______

Address City Prov Postal Code

______Prefer to be reached at: Home ___ Work ___

Home Phone Number Work Phone Number

______

OccupationEmployer/Educational Institution

______

If you are a student, area of study

Do you possess a driver’s license? ____ yes ____ no If yes: ______

Class

______Indicate any medical problems: ______

Medical Plan #

______

Name of Emergency ContactPhoneRelationship

Please provide three references other than family (adults only):

NamePhoneCityProvRelationship

1.______

2.______

3.______

Would you agree to a criminal record check? ____ yes ____ no

Do you have a criminal record with the RCMP or any other police force? ____ yes ____ no

______

If you wish, you may provide details here

Put an X (X) next to the activities that interest you. Put two X’s (XX) next to the activities that you are able to teach.

Physical Activities:

Aerobics ____Dancing ____Skating ____

Archery ____Floor Hockey ____Skiing ____

Badminton ____Hiking _____Soccer ____

Baseball ____Orienteering ____Swimming ____

Bowling ____Racquetball ____Tennis ____

Cooperative Games ____Rollerblading ____Volleyball ____

Curling ____Self Defense ____Wrestling ____

Arts and Crafts:

Baking ____Macrame ____Tye Dying ____

Beading ____ModelBuilding ____Woodwork ____

Ceramics ____Music _____Wood Carving ____

Cooking ____Painting ____Paper Mache ____

Drama ____Plaster Craft ____Drawing ____

Leather-work____String Art ____

Other Activities:

Computer Training ____Trips, Tours ____Literacy Training ____

  1. Education, special training, courses, etc.

______

______

  1. Personal interests, hobbies, skills, (be specific)

______

______

3. Previous experience with children, youth and families

______

______

4. Community participation: Clubs, associations, teams, service groups, etc.

______

______

5. Relevant work history

______

6. What did you enjoy most about your previous volunteer/work experiences?

______

7. What did you enjoy least about your previous volunteer/work experiences?

______

8. How did you learn about the Boys and Girls Club of Kamloops?

______

9. Why do you wish to volunteer with us?

______

  1. How many hours/week are you able to commit to volunteer work? ______

Preferred Day(s) ______Hours Available ______

Preferred location ____ McArthur Island____ Brocklehurst____ Upper Sahali ____ Lower Sahali ____ Dallas

11. Are you looking for a short term placement? ____ yes____ no

If "yes", how long will you be available? ______

Personal Information Protection Act

The Boys and Girls Club of Kamloopsis committed to protecting the privacy of the personal information of our employees, volunteers, members, participants and their families, donors and other stake holders and we have developed appropriate policies to safeguard that personal information:

We respect the privacy of our volunteers and will only use the information collected on your application form for the following purposes:

  • The information collected will be used for tracking statistics that pertains to volunteering.
  • The information collected may be used to send out agency newsletters, appreciation invitations, upcoming educational workshops, and notices with respect to events or fundraisers.
  • Volunteer information or contact information will not be transferred or used except on behalf of the Boys and Girls Club of Kamloops. Mailing lists will not be sold or lent; however, name and contact information may be shared with another organization for a joint fundraising event.

PLEASE NOTE: All information on a volunteer created by, or on behalf of, the Boys and Girls Club of Kamloops will be kept confidential to the greatest extent possible. Access to this information is limited to a few employees who are not permitted to use this information in any way other than to carry out their duties and for the reasons that the information was obtained.

By completing this application I am agreeing that all of the information I have provided is true and that I am giving my permission for a criminal records check and child abuse registry check to be conducted by Boys and Girls Club of Kamloops.

______

NameDate

The “Strength-based volunteer application” was developed bythe Boys and Girls Club of Kamploops, B.C..This information may be reproduced for non-commercial, educational and outreach purposes only.