American Red Cross  Darien/Stamford Chapter
Volunteer Sign Up Form

Volunteer Name:

First
Middle
Last

Prefix

Ms      Mrs       Mr     Dr     Rev

Home Address:

Street Address
Address (cont.)
City
State
Zip
Home Phone	include area code
*E-mail

Business Information:

Employer
Street Address
Address (cont.)
City
State
Zip
Work Phone	include area code

E-mail

Emergency Contact Information: (For anyone under the age of 18, must be a parent/guardian)

Name: First
Middle
Last

Prefix

Ms      Mrs       Mr     Dr     Rev

Relationship to you

Street Address
Address (cont.)
City
State
Zip
Day Phone	include area code
Evening Phone	include area code

Languages:

Please list any language(s) other than English with which you are completely fluent

Statistics Sought by Our National Office (optional):

Race/Ethnicity:

African American
Hispanic
American Indian or Alaskan Native
White (not of Hispanic Origin)
Asian or Pacific Islander

Gender:

Male
Female
 

Education and Training Beyond High School:

College
Post Grad
Masters
Other

Are you hoping to fulfill a community service obligation
by volunteering for the American Red Cross:

Yes
No

Skills & Previous Volunteer Experience,
including previous Red Cross experience:

Please list any skills, certification, needs or interests that should be considered when trying to provide you with a productive and pleasant work experience.   Also list any previous volunteer positions held.

Reason(s) for volunteering
(Include who referred you to the Darien/Stamford Chapter)

We hold monthly volunteer orientations where you can learn more about volunteer opportunities and sign up for your area of interest. We will contact you soon to sign up for an orientation.

Volunteer Consent for Reference and Background Checks

I do hereby give the American Red Cross, Darien/Stamford Chapter permission to inquire into my employment, volunteer history, or police record. I further give permission to the holder of any such records to release the same to the American Red Cross. I hereby hold the American Red Cross harmless of any liability, whether civil or criminal that may arise as a result of the release of this information about me.  I further hold harmless any individual, agency, business, or corporation that provides information or documents to the above named American Red Cross unit. I understand that the American Red Cross will use this information as part of its verification of my volunteer application. I

I have carefully read and agree to the Volunteer Consent statement
I do not agree. By not agreeing I understand that I may not qualify to volunteer