Last Name:
First Name:
Street Address:
Apartment/Unit #:
City:
State:
Zip:
Phone #:
Email Address:
Cell #:
Work #:

EMERGENCY CONTACT
Last Name:
First Name:
Phone:
Alt. Phone:

SKILLS/INTERESTS
Working with the publicClerical workChildren’s servicesSpecial EventsArt/bulletin boards/display casesCounselorTutoring in reading/writing/ skillsPsychology
Teaching classes/what subject?
Other:

EDUCATION - Please list the institution last (or currently) attended
Institution:
Degree:

AVAILABILITY - Please indicate your availability below
Mon MorningsAfternoonsEvenings
Tue MorningsAfternoonsEvenings
Wed MorningsAfternoonsEvenings
Thu MorningsAfternoonsEvenings
Fri MorningsAfternoonsEvenings
Sat MorningsAfternoonsEvenings
Sun MorningsAfternoonsEvenings

PARENT/GUARDIAN INFORMATION (REQUIRED FOR APPLICANTS UNDER 18)
Last name
First Name
Street Address
Apartment/Unit #
City
State
Zip
Phone
E-Mail Address
I certify that I am the parent/guardian for this applicant.

Volunteers must be at least 17 years of age, unless participating as part of a service organization. In the interests of public health and safety, all Ayaks Helping Hands volunteers are required to pass a background check, and some may be required to pass a medical exam before they begin volunteering.