YOUTH SERVICE, INC. and Anthony Martin Present

347 YSI Logo

YOUTH SERVICE, INC. and Anthony Martin Present

17th Annual Teen Conference

VOLUNTEER APPLICATION

Youth Service, Inc. is an equal opportunity employer, complying with all applicable federal, state and local laws.

PERSONAL INFORMATION (Please type or print clearly)

Full Name (Dr., Mr., Mrs., Ms.): / Preferred Name:
Mailing Address: / City: / State: / Zip:
Phone: / Secondary Phone: / Email:
Date of Birth:

EMERGENCY CONTACTS

1st Name: / Relationship: / Phone:
2nd Name: / Relationship: / Phone:

If emergency contacts cannot be reached, Youth Service, Inc. reserves the right to seek medical assistance at the nearest medical facility and will be held harmless in all legal issues that may arise from this decision.

EMPLOYMENT & EDUCATION INFORMATION

Current or most recent employer: / Position: / Since: / MM/YYYY
Other places you have worked:
Current or most recent educational program: / Degree: Completion Date: MM/YYYY
Credentials and Certificates:

Are you interested in receiving more information about Youth Service, Inc. through our electronic newsletter?

Please indicate your T-Shirt size below:

VOLUNTEER POSITIONS

Please select the volunteer position in which you are interested:

Registration Team

Assist with the morning registration. Help teens sign in by initialing next to their name. If they are not on the “Check-in List” have them complete a registration form and then sign in using the blank “Check-in List”. If we do not have their photo release please have them sign a photo release form. Once registered, have them write their name on a name tag, give them a photo wristband (if applicable) and give them the rest of their materials.

Five volunteers are needed from 7:45 to 11 am.

Outside Greeters

In the morning stand outside of the building. Greet youth with warm & welcoming smile. Direct them to the registration table on the 2nd floor. Three volunteers are needed from 8:15 to 10 am.

Morning Set Up

Help the staff set up and decorate for the conference. Help carry materials upstairs if needed. Five volunteers are needed from 7:45 to 9 am.

YouthRep

In the morning, greet youth with warm & welcoming smile as they arrive to the 2nd floor. Direct them to the registration table first and then to the banquet room. Help manage the line for registration

During breakout sessions, direct youth to assigned rooms for sessions. Direct to bathrooms as needed, answer questions or direct to person who can answer question. Help seat the youth at tables and make conversation break the ice etc. Three volunteers are needed from 8:30 am to noon.

Food Handler

Set up breakfast as needed. Youth and guests can serve themselves but assist where needed and maintain cleanliness. When lunch arrives assist with set up as needed. Serve food to youth and guests. After everyone has been served get a lunch for yourself then interact with youth and spark conversations. If there are leftovers allow students to get seconds but make sure you take time to eat. Three volunteers are needed for the breakfast shift (8:30 to 10:30 am) and 3 volunteers are needed for the lunch shift (11:30 am to 1:30 pm).

Room Assistant

Assistants will be assigned to one of the breakout session groups. In the morning introduce yourselves to youth, welcome them to conference, spark conversations (use suggested questions if needed) and manage behavior as needed. During breakout sessions, help in the coach in sessions as needed. Be available to assist workshop leader. Six volunteers are needed from 8:30 am to 3 pm.

Hallway and Bathroom Monitor

Monitor the hallways, help teens find where they are going, direct to the bathrooms and manage behavior as needed. Four volunteers are needed from 8:45 am to 3 pm.

Clean Up Crew

Help keep the facilities clean during breakfast and lunch. Assist in cleaning up after meals and after the conference ends. Three volunteers are needed for the breakfast shift (8:30 to 10:30 am) and 3 volunteers are needed for the lunch shift (11:30 am to 1:30 pm).

Conference After-party Volunteer

Help facilitate the conference after-party activities and help clean up after the party ends. Five volunteers are needed from 2:45 am to 5 pm.

VOLUNTEER DISCLOSURE STATEMENT

(Required by Child Protective Services Law, 23 PA C.S.A. 6344 (a))

I swear/affirm that I have not been named as a perpetrator of a founded report of child abuse as defined by the Child Protective Services Law within the preceding five years.

I swear/affirm that I have not been convicted of one or more of the following crimes under Title 18 of the Pennsylvania Consolidated Statutes or equivalent crime in another state within preceding five years.

Chapter 25 (relating to criminal homicide)

Section 2702 (relating to aggravated assault)

Section 2709.1 (relating to harassment)

Section 2901 (relating to kidnapping)

Section 2902 (relating to unlawful restraint)

Section 3121 (relating to rape)

Section 3122.1 (relating to statutory rape)

Section 3123 (relating to involuntary deviate sexual intercourse)

Section 3124.1 (relating to sexual assault)

Section 3125 (relating to aggravated indecent assault)

Section 3126 (relating to indecent assault)

Section 3127 (relating to indecent exposure)

Section 4302 (relating to incest)

Section 4303 (relating to concealing death of a child born out of wedlock)

Section 4304 (relating to endangering welfare of children)

Section 4305 (relating to dealing in infant children)

A felony offense under Section 5902(b) (relating to prostitution and related offenses)

Section 5903(c) or (d) (relating to obscene and other sexual material and performances)

Section 6301 (relating to corruption of minors)

Section 6312 (relating to sexual abuse of children)

A felony offense under the Act of April 14, 1972 (P.L.233, No. 64), known as the controlled Substance, Drug, Device and Cosmetic Act.

I understand that as a volunteer I must work within eyesight of a regular employee at all times.

I understand that I must be dismissed if I have been named as a perpetrator of a founded report of child abuse within the past five years or have been convicted of any of the crimes listed above.

I understand that this position as a volunteer may be terminated if I have been named as a perpetrator of a founded report of child abuse longer than five years ago, or the perpetrator of an indicated report of child abuse.

I hereby swear/affirm that the information as set forth above is true and correct. I understand that the penalty for false swearing is a misdemeanor of the third degree pursuant to Section 4903(b) of the Crimes Code.

Signature: / Date:

Please return completed form via e-mail to the Marketing Coordinator at . If you do not have email access please mail or fax completed form to:

Youth Service, Inc.

410 N. 34th Street

Philadelphia, PA 19104

215.222.3262 (p)

215.222.2352 (f)

Attn: Marketing Coordinator