• • Name *
    
    First
    
    Last
• • Date of Birth
    
    All applicants must be between the ages of 13 and 19 years old.
• • Address *
    
    
• • Home/Main Phone Number *
    
    
    
    
    
    
• • Cell Phone Number
    
    
    
    
    
    
• • Email
    
    
• • Name of School
    
    
• • Current GPA
    
    
• • Academic awards or honors:
    
    
• • Current extra-curricular activities:
    
    
• • Past extra-curricular activities:
    
    
• • Work Experience (most recent)
    
    
• • From
    
    
• • To
    
    
• • Responsibilities
    
    
• • Work Experience (past)
    
    
• • From
    
    
• • To
    
    
• • Responsibilities
    
    
• • Volunteer Work
    
    
• • Responsibilities
    
    
• • From
    
    
• • To
    
    
• • Other Volunteer Work
    
    
• • From
    
    
• • To
    
    
• • Responsibilities
    
    
• • Check the days/hours currently available to volunteer
    Monday 6:00pm – 8:30pm
    Tuesday 6:00pm – 8:30pm
    Wednesday 6:00pm – 8:30pm
    Thursday 6:00pm – 8:30pm
    Sunday 9:00am – 12:00pm
    
• • What date are you available to start work?
    
    
• • Do you have reliable transportation to and from volunteer shifts?
    Yes
    No
    
• • Referrance #1
    
    Please list three people who know you well and can attest to your character, skills and dependability (NOT family members)
• • Phone Number
    
    
    
    
    
    
• • Relationship
    
    
• • Length of Relationship
    
    
• • Referrance #2
    
    Please list three people who know you well and can attest to your character, skills and dependability (NOT family members)
• • Phone Number
    
    
    
    
    
    
• • Relationship
    
    
• • Length of Relationship
    
    
• • Referrance #3
    
    Please list three people who know you well and can attest to your character, skills and dependability (NOT family members)
• • Phone Number
    
    
    
    
    
    
• • Relationship
    
    
• • Length of Relationship
    
    
• • Have you completed Safe Sanctuary training within the last 4 years?
    Yes
    No
    
• • Please read the following carefully before signing this application:
    
    I understand that this is an application for and not a commitment or promise of volunteer opportunity. I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and in interviews with LUMC Childcare Coordinators that is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with LUMC Nursery and Kidcare or my termination as a volunteer.

NOTE: Do Not Alter These Fields: