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?

African American   Caucasian   Native American
Asian   Hispanic   Other

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.

Sports   Church Activities   Clubs
Student Government    Arts: (please check)
    Drama  Music  Visual  Dance

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.

  Name Relationship Work # Home #
A.
B.