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Volunteer Application

  Tell us about yourself.

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Name:

 

 

   

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City/State/ZIP:

 

    

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Date of Birth:

 

If you respond and have not already registered, you will receive periodic updates and communications from A Kid Again.


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Question - Required - What can you help with?
Please make at least 1 selection from the choices below.

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Question - Required - Which geographical area would you like to volunteer in?




 

 

CERTIFICATION STATEMENT:

 

By signing below, I hereby submit this application to become a volunteer for A Kid Again and certify that the information provided herein is true and accurate without any omissions.  I agree and consent to the fact that A Kid Again may have an unaffiliated third party entity conduct a background check on me to assess my suitability as a volunteer. I agree and consent that A Kid Again may periodically recheck my background; I understand that I may withdraw consent at any time.  I further agree and consent that such third party performing the background check may contact me for additional information and I agree and consent to such third party entity sharing the results of the background check with A Kid Again.   I also agree that as a volunteer of A Kid Again I will abide by all the rules and procedures of the organization. 

AUTHORIZATION FORM FOR CONSUMER REPORTS 

            In connection with your employment/volunteer application or retention as an employee, consumer reports or investigative consumer reports which may contain public record information may be requested or made on you including, but not limited to criminal records, driving record, education, prior employer verification, employment history including all personnel files, birth records, social security number verification, date of birth verification, current and previous residences, character references, workers compensation claims and others.  These reports may include experience information along with reasons for termination of past employment.  Information from various Federal, State, local and other agencies which contain your past activities will be requested.

            By filling out electronic signature and date below, you hereby release A Kid Again, and its agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may at any time result to you, your heirs, family or associates because of compliance with this authorization and request to release information. You may be contacted as indicated below.  A copy of this authorization (if not previously destroyed in accordance with record retention policies) will be given to you, provided you request it in writing.

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Question - Required - Enter Date




 

If you would prefer to submit your application via email please print and fill out the application. You can then scan the application and email to Kathy Derr.

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