By completing this form and sending it to us, you are registered either as a Retired & Senior Volunteer Program member (those 55 years of age and over), or as a Seminole Volunteer Center member (those under the age of 55). You will be contacted within 48 hours (excluding weekends) for verification and placement.

When you're done with the form, press FINISHED to send it.

Participation:
We have something for everyone!

Individual
Family
Group

Type of Assignment:
We will work around your schedule!

Ongoing Assignment (consistent days per week, per month, etc.)
Special Projects (one-time events, special requests events)

Areas of Interest:
We know you're versatile, so check all that apply!

Government
Seniors
Schools
Environment
Public Safety
Animals
Health & Human Needs (hospitals, clinics, food & clothing distribution, shelters, etc.)
Volunteer Leadership (heading up special projects, leading groups of volunteers)
Disaster Response & Recovery (donation sites for food & clothing distributions, needs assessments, phone bank management, information and referral)

Name:
Date of Birth:
Address:
City, State, ZIP:	,
Home Phone:
Work Phone:
Other Phone:

Will you be driving to and from your volunteer station?

Yes
No

If yes, please enter your Driver's License Number:

And your Auto Insurance and Policy Number:

Disabilities:
Special Interests or Hobbies:
Emergency Contact Name:
Relationship:
Phone:
SCVP provides Accident and Liability insurance during your volunteer hours; please designate a beneficiary.
Name:
Relationship:
Phone:
Address:
City, State:	,
ZIP Code:

Where are you presently volunteering? (Name of agency)

How did you hear about SCVP?