Short Term Volunteer Application - Adult

Name*
Prefix First Middle Last
Gender
- Male
- Female
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone
Email
Birth Date
Date Format: MM slash DD slash YYYY
Registered Bahá’í*
- Yes
- No
If yes, ID #
Proposed Service Term - Start Date
Date Format: MM slash DD slash YYYY
Proposed Service Term - End Date
Date Format: MM slash DD slash YYYY
Do you have health insurance coverage?*
- Yes
- No
Insurance Company
Policy Number
ALL VOLUNTEERS ARE RESPONSIBLE FOR THEIR OWN MEDICAL COSTS
Do you have any medical or other conditions that might impact your ability to serve? If so, please describe:
[Please also note that the School is a smoke-free and tobacco-free campus.]
Emergency Contact #1
Contact #1 Name
Contact #1 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact #1 Home Phone
Contact #1 Work Phone
Contact #1 Cell Phone
Emergency Contact #2
Contact #2 Name
Contact #2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact #2 Home Phone
Contact #2 Work Phone
Contact #2 Cell Phone
References
Volunteers are required to provide two references: 1) a non-family member who is personally acquainted with the applicant (provide information below) and 2) a Bahá’í serving in an administrative capacity (ask them to return the attached Short Term Volunteer Reference form directly to Green Acre at greenacre@usbnc.org).
Reference Name
City, State(Province)
Home Phone
Work Phone
Cell Phone
Email
Other Email
Bahá’í Experience:
Describe your experience as a Bahá’í including the communities in which you have lived, committees and Assemblies of which you have been a member, institute programs and/or classes you have attended or taught, conferences attended, pioneering, teaching activities, children’s classes taught, home visits completed, etc. Please include dates if known:

Short Term Volunteer Application – Adult

Emergency Contact #1

Emergency Contact #2

References

Bahá’í Experience: