RSVP of Central Oklahoma Volunteer Registration Form

Name*

First Middle Last

Birthdate*

Mailing Address

Street Address City ZIP / Postal Code

Email

Home Phone*

Cell Phone

Gender

Do you have any physical/medical limitations?

Describe your physical limitations:

Are you a past member of RSVP?

Are you a Veteran?

Do you drive?

Ethinicity

(You are not obligated to disclose your ethnicity. We request this information to only comply with federal civil rights laws.)

Have you ever been convicted of a criminal offense?

If yes, please attach an explanation of charges, date of offense and status of the charges on a separate sheet to be included with this application.

Employment Experience:

Special Skills/Interests:

How did you learn about RSVP?

Have you ever volunteered before?

Volunteer Experience (Current, Past, Preferred)

Days/Hours Available:

As a volunteer, you will receive free accident and personal liability insurance. Please provide the following information.

Emergency Contact

First Last

Relationship

Phone

Name of beneficiary for RSVP Supplemental Accident Insurance

First Last

Relationship

Phone

RSVP of Central Oklahoma may photograph, record video, or take statements from volunteers at RSVP events and/or during the course of a volunteer’s duties to be shared and used in a respectful manner for communications, marketing efforts, and reporting. Please indicate if RSVP may have permission to use your name, image, likeness, and/or statements:

I grant RSVP of Central Oklahoma permission to use my name, image, likeness, and/or statements in its publications or on the Internet (including on rsvpokc.org, social media accounts, and via email). I agree to make no monetary or other claim against RSVP of Central Oklahoma for the use of this material. I understand that I may request that RSVP of Central Oklahoma remove a specific instance of my name, image, likeness, or statement from its live digital platforms at any time.
I do not grant RSVP of Central Oklahoma permission to use my name, image, likeness, or statements.

Please indicate if RSVP may have your permission to perform a confidential background check?

I understand that RSVP may at their own expense and discretion choose to perform confidential background checks on any/all registered members. I hereby give my permission for such checks to occur.
I do not give permission to perform confidential background checks.

Do you prefer a magnet or pinback name badge?

Magnet (not recommended for use with pacemaker)
Pinback

Certifications

By signing below, I acknowledge that I have read and understand the following statements: 1) I hereby state that I am 55 years of age or older and offer my services as a volunteer for RSVP of Central Oklahoma. I understand that I am not an employee of RSVP of Central Oklahoma, the volunteer agency in which I serve, or the Federal Government and agree to serve without compensation. 2) I understand that in my capacity as a RSVP volunteer I may come into contact with confidential information. I agree to protect this information to the best of my ability and not to disclose it during or after my service as a volunteer has ended. 3) I understand that if I use my personal automobile in my volunteer service, I will arrange to keep in effect automobile liability insurance equal or greater to the minimum requirements of the state of Oklahoma. I will also keep in effect a valid driver’s license.

Please type name here for Signature:*

Date*

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Volunteer Registration Form

RSVP of Central Oklahoma Volunteer Application Form

As a volunteer, you will receive free accident and personal liability insurance. Please provide the following information.

Certifications