Name *
Nickname (optional)
Nickname (optional)
Date of Birth (must be 16 years or older) *
Date of Birth (must be 16 years or older)
Phone Number *
Phone Number
Type of phone *
Current (local) Address *
Current (local) Address
LOCAL Emergency Contact *
LOCAL Emergency Contact
Emergency Contact Phone Number *
Emergency Contact Phone Number
Are you currently: *
If you are volunteering as part of a group or organization, please list the group name below:
How did you hear about us?
If yes, please speak with the Volunteer Coordinator.
The following positions are available. Please check all that you're intersted in: *
Descriptions of positions can be found at in the Volunteer Tab!
Please indicate the time and days you are availableto volunteer. *
Volunteers are required to commit to at least 4 hours per week, in no shorter than 2 hour shifts. Remember that promptness and reliability are VERY important.
I agree to advise the AHHS in writing of any physical limitations which could affect or be affected by any volunteer activities I assume. I understand it is my responsibility to provide this information and I release the AHHS from any liability for injuries or illnesses which result from my failure to advise the AHHS in writing of any such limitations. I agree and understand that as a volunteer, the AHHS is not obligated to provide me any payment or benefit for my services. I also agree to release AHHS, its employees and agents from any liability in the event I am injured or suffer damage as a result of my volunteer activities at the AHHS. I agree not to pursue any claim or initiate any action against the AAHHS in the event I am injured or suffer damage as a result of the negligence of the AHHS. I understand and agree that this is an express assumption of risk and this release and waiver is made on my own behalf and on behalf of my heirs, executors, representatives and assigns. I understand that the AHHS may require alcohol, drug and substance abuse screening, and I consent to such an examination and authorize the release of the results of such an examination to the AHHS. I hereby authorize a law enforcement background check and investigation of all statements in this application and request any company, institution, or persons, including police agencies, contacted as part of this investigation to provide any and all pertinent information. To assure their cooperation, I hereby release them from all liability of any damage that may result from furnishing same to AHHS. All information provided herein is true, correct and complete.
I have read, understand and agree to the above statements. *