DEARBORN & OHIO COUNTY
RED CROSS VOLUNTEER APPLICATION

Please fill out the form below and then press the SUBMIT button when finished. Required fields are indicated with a red asterick. We will receive the form via email and contact you via phone or email.

If you prefer, we have a printable form which you can open, print , fill out, and then fax or mail to us. Printable version requires Acrobat Reader. Open Printable Form ---- Get Adobe Reader

Name * required

County

Address
City/State/Zip
Email Address
Mobile Cell Phone
Home Phone * required

 Work Phone

Business or Employer
Occupation

Employer Address

Employer City/State/Zip


Union Member ? Yes No
If Yes, Which Union ?



I'd rather volunteer...
Short Term Continuous Basis

I am available...
Weekdays Evenings Weekends

Education Level...
High School College/Tech Degree


   

In Case of Emergency, please notify:

Name:

Phone:

Relationship:


Do you have any health condition that would impact your ability to volunteer?
Yes No

If Yes, Please Describe

Acknowledgement of Responsibilities: As a Red Cross Volunteer, I will work cooperatively with other members of the staff, uphold my responsibilities and keep my commitments.

I have read this statement and agree with the terms as stated. --- I agree I disagree

OPTIONAL: The following data will be used to assist in ensuring greater diversity in volunteer representation. This section is completely optional.

Gender:

Male
Female

Date of Birth:

Race:

White, not Hispanic
Black, not Hispanic
American Indian
Hispanic
Asian or Pacific Islander

What areas interest you ?

Disaster Action Team
Office Assistance
Fundraising
Educational Programs
Other
if other, please describe

Any specific area of interest you would like to explore?


Have You volunteered before?

Yes
No


If you have volunteered, Where ?

What duties?


List Skills & Abilities :



List Interests and Hobbies :





Describe your major work experience:

Describe your expectations from volunteering:

Photo Release: The Dearborn and Ohio County Red Cross and/or the National Red Cross organizations have my permission to use general information about my volunteer work, and to use any photographs taken of me while volunteering, for promotional purposes for the Red Cross
.
I have read this release statement and agree with the terms as stated. --- I agree I disagree

For safety reasons, please read and fill in the number you see in the block below: