Volunteer Enrollment Form | St. Charles Parish, LA

Please correct the field(s) marked in red below:

If you would like to print a paper copy of this form, click here.

INFORMATION BELOW IS REQUIRED INFORMATION FOR ENROLLMENT

Please complete all sections. YOU MUST PROVIDE A COPY OF YOUR ID OR DRIVER’S LICENSE.

If you would like to print a paper copy of this form, click here. INFORMATION BELOW IS REQUIRED INFORMATION FOR ENROLLMENT Please complete all sections. YOU MUST PROVIDE A COPY OF YOUR ID OR DRIVER’S LICENSE.

Name

Birth date (MM / DD / YYYY)

Street address (including city, state and zip code)

Mailing address (including city, state and zip code)

Phoneext.

Alternate phoneext.

Do you have a car?

Yes

Claiming mileage reimbursement?

Yes

Driver’s license number

State

Expiration date

*If claiming mileage reimbursement, please include a copy of your proof of insurance.

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Emergency contact

Phoneext.

Beneficiary for RSVP supplemental accident insurance

Name

Relationship

Address (including city, state and zip code)

Phoneext.

Employment experience

Skills / interests / languages

Volunteer experience

Days / hours available

Would you like to be included on our special on-call list? This is a list we refer to when local non-profits are looking for one time assistance with special events or fundraising events. We will call volunteers on our list when we receive requests for assistance from the non-profits.

Yes

I understand that I am not an employee of the RSVP project, the sponsor, the volunteer station or the Federal Government and agree to serve without compensation. I further agree that if I use my personal automobile to drive to and from my volunteer station or during my service, I will keep in effect automobile liability insurance equal to or greater than the minimum required by the state. An RSVP staff member will sign and date this form before filing.

Type your name in all caps here to represent your signature

Date

This information will be used by the sponsor for statistical purposes only. It will only be used in the aggregate, and will not be compiled or disseminated in ways that will identify the individuals. This information will not be used in evaluating assignments or placements. Completion of this section is strictly voluntary. Failure to respond will in no way affect your consideration for available volunteer opportunities.

Are you Hispanic or Latino?

Yes

What is your race? (Select one or more.)

American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.

Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American. A person having origins in any of the black racial groups of Africa.

Native Hawaiian or other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands.

White. A person having origins in any of the peoples of Europe, the Middle East, or North Africa.

Are you a veteran?

Yes

Are you a RETIRED veteran?

Yes

If YES, what branch of the military did you serve in?

Do you volunteer for any veteran organizations?

Yes

If YES, please list

Are you the spouse of a veteran?

Yes

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