VOLUNTEER HOUSTON COUNTY "YOUTH VOLUNTEER CORPS" 2841 MOODY ROAD, BONAIRE, GA 31005 929-5464 | e-mail: info@vhc-cishc.org | fax: 929-5427
Name:
Nickname:
Telephone:
Birthday:
Age:
E-mail:
This is my ___ year with Volunteer Houston County. 1st 2nd 3rd 4th
Address:
City/State/Zip:
County:
School:
Class of:
Student ID No.:
What is your ethnic background?
Why did you volunteer? (Check all that apply.) I was looking for something fun to do. I was interested in searching for a career. I wanted to be with a friend who was volunteering. I wanted to give something back to the community. I saw a problem and wanted to do something about it. Other
Tell us about any volunteer or work experiences you have had. (Include such things as baby-sitting, Sunday School, Scouting, chores, hobbies, etc.)
Please identify and check any activities you are involved in at school or other organizations.
Does your parent/guardian work on (or have they retired from) Robins Air Force Base or the US military service? Yes No
Do you have transportation available to you? Yes No
Do you have any disabilities or illnesses of which we should be aware in order to accommodate you in your volunteer work?
Please list the name, relationship, and work/home phone numbers of the person(s) we should notify in case of an emergency.