Volunteer Application Volunteers under the age of 18If under 18, please print the application and submit with signatures.Personal InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Sex*FemaleMaleEthnicityDate of Birth* Place of WorshipProfessional InformationEmployment Status* Student Employed Retired Other Employer*Class Credit*YesNoYou chose 'other' for employment status. Please explain.What prompted you to volunteer?Referred byVolunteer InformationAreas of Interest* Classroom Enterprise Home Repairs Special Events Administrative/Clerical Special Skills/CertificationsCheck Days and Hours AvailableMorning Sunday Monday Tuesday Wednesday Thursday Friday Saturday Afternoon Sunday Monday Tuesday Wednesday Thursday Friday Saturday Evening Sunday Monday Tuesday Wednesday Thursday Friday Saturday Emergency InformationPlease list at least two contacts in case of an emergency.1. Contact Name First Last RelationshipPhone NumberCell Phone2. Contact Name First Last RelationshipPhone NumberCell PhoneKnown AllergiesRELEASE AND LIABILITY WAIVERIn consideration of Reach Unlimited allowing me the opportunity to participate in the above event: I hereby represent that I am eighteen (18) years of age or older, that I am in good health, and have no known conditions that would be impacted in any way by performance of my volunteer duties. I am not under the influence of any alcohol or any drugs which would impair my to safely volunteer for the event. I have never been charged with, arrested for, or convicted of, any felony or been charged with, arrested for, or convicted of, any other crime other than a traffic violation. My participation in the events organized by Reach Unlimited is voluntary. I assume all risks associated with my participation in this event including injuries or illness to person and damage or loss to property. For any injury, illness, property damage or loss suffered or sustained by me which is in any way associated with my participation in, travel to and from, or other activity associated with the noted event, I do hereby, for myself, my heirs, my administrators and executors forever waive, release and discharge and agree to indemnify for any and all rights and claims, for expenses, damages or other losses which I or the Minor may have or which may hereinafter accrue, against: Reach Unlimited, Inc. Including sponsors, and organizations or their respective representatives, officers, directors, employees, agents, successors, and assigns. This Volunteer’s Acknowledgment, Waiver, and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I hereby warrant that I am of legal age and competent to enter this Agreement, that I have read this Agreement carefully, understand its terms and conditions, acknowledge that I will be giving up substantial legal rights by signing it (including the rights of my spouse, children, guardians, heirs and next of kin, and any legal and personal representatives, executors, administrators, successors and assigns) acknowledge that I have signed this Agreement without any inducement, assurance or guarantee, and intend for my signature to serve as confirmation of my complete and unconditional acceptance of the terms, conditions and provisions of this Agreement, I hereby certify that I have read this document and that I understand its content. I certify that all information provided in this volunteer application is true and complete. I understand that my false information or omission may disqualify me from further consideration and may result in my dismissal if discovered at a later date. I understand, also, that I am required to abide by all rules, policies and procedures of Reach Unlimited Inc.I hereby acknowledge that I have read and understand the preceding statements. First Last Date DISCLOSURE OF CRIMINAL HISTORYI certify that I have no record of conviction in any of the following offenses; nor have I ever plead guilty or no contest to such a charge: Offenses listed in the following chapters of the Penal Code 19 (Criminal Homicide) 20 (Kidnapping and Unlawful Restraint) 21.02 (Continuous sexual abuse of child/children) 21.08 (Indecent exposure) 21.11 (Indecency with a child) 21.12 (Improper relationship between educator and student) 21.15 (Improper photography or visual recording) 22.011( Sexual assault) 22.02 (Aggravated assault) 22.021 (Aggravated sexual assault) 22.031 (Agreement to abduct from custody) 22.04 (Injury to a child, elderly individual, or disabled individual) 22.041 (Abandoning or endangering a child) 22.05 (Deadly conduct) 22.06 (Solicitation of a child) 22.07 (Terroristic threat) 22.08 (Sale or purchase of a child) 22.08 (Aiding suicide) 28.02 (Arson) 29.02 (Robbery) 29.03 (Aggravated robbery) 33.021(Online solicitation of a minor) 34.02 (Money laundering) 35A.02 (Medicaid fraud) 36.06 (Obstruction or retaliation) 37.12 (False identification as a peace officer) 42.01 (Disorderly conduct) 42.09 (Cruelty to livestock animals) 42.092 (Cruelty to non-livestock animals) A conviction under the laws of another state, federal law, or the Uniform Code of Military Justice for an offense containing elements that are substantially similar to the elements of an offense listed above. Further more, I understand that REACH UNLIMITED, INC. shall conduct a criminal background check on my application and that a record of conviction found for any of the above-captioned offenses will result in the immediate severance of my volunteer relationship with Reach Unlimited, Inc.I understand the Disclosure of Criminal History above. First Last Date CommentsThis field is for validation purposes and should be left unchanged.