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KENNEWICK RECREATION AND COMMUNITY SERVICES 210 W. 6TH AVE, KENNEWICK, WA 99336 PHONE: (509) 585-4293 E-MAIL: [EMAIL REDACTED] Volunteer Volunteer Volunteer Volunteer Application Application Application Application Form Form Form Form (Please PRINT. Complete as fully as possible and return to Please PRINT. Complete as fully as possible and return to Please PRINT. Complete as fully as possible and return to Please PRINT. Complete as fully as possible and return to the the the the Kennewick Kennewick Kennewick Kennewick Recreation Recreation Recreation Recreation office) office) office) office) Full Name: Address: City/State/ZIP: Day Phone: Evening: Availability: Hours/days available? Su M T W Th F Sa AM PM On-going____ On-call (Please circle) (Please circle) (Please circle) (Please circle) Male Female Youth Adult (no age needed) Emergency Contact Name Phone Number: Emergency Contact Name Phone Number: Do you currently volunteer anywhere? Yes No If “yes”, please tell us where: Contact person of above: Day Phone: Volunteer Interests: Youth Sports Youth Activities Special Day Camp Office Work/Clerical Other List any skills, coaching/playing experience that you may have: (For example: typing, working w/the public, teaching a craft/class, computer skills, foreign languages, coaching and/or playing a sport, etc.) Have you been convicted of a crime by a court of law within the last 10 years? Yes No (A conviction will not necessarily bar you from volunteering.) Please list two personal references who can speak knowledgeably of your ability to volunteer: NAME ADDRESS TELEPHONE OCCUPATION YEARS KNOWN 1. 2. I understand that all information on this form is voluntarily supplied and may be disclosed for volunteerism purposes only. I hereby volunteer my services and understand that I am not a paid employee of Kennewick Recreation and Community Services or the City of Kennewick. I agree to keep all information about clients, volunteers, or other individuals, obtained while volunteering, confidential. I realize and understand that there are certain risks inherent in the activity for which I am volunteering for. Also, in consideration of the fee charged for this program, I agree to hold the city of Kennewick, Pasco, Richland, all school districts involved in the program, and any employee or volunteer involved in the program harmless from, and indemnify them for, any damage or loss arising as a result of my (my child’s) participation in this activity. I give permission to have my (my child’s) photo taken during this program and used for publicity purposes by the City of Kennewick. I hereby give my consent for emergency medical treatment. I understand that this is to prevent undue delay and assure prompt treatment and that only a licensed healthcare provider will be engaged for such an emergency. Volunteer Signature (or Parent/Guardian for minor child) Date Signed **Please complete the Please complete the Please complete the Please complete the attached attached attached attached form form form form for for for for Authority for Release of Information Authority for Release of Information Authority for Release of Information Authority for Release of Information. . . . Return Return Return Return to the Kennewick to the Kennewick to the Kennewick to the Kennewick Recreation Services Recreation Services Recreation Services Recreation Services, , , , PO Box 6108, PO Box 6108, PO Box 6108, PO Box 6108, 210 W. 6 210 W. 6 210 W. 6 210 W. 6th th th th Ave. Ave. Ave. Ave., Kennewick, Washington, 99336. , Kennewick, Washington, 99336. , Kennewick, Washington, 99336. , Kennewick, Washington, 99336.