Online Youth Volunteer Application
Welcome to the Worthington Resource Pantry (WRP).  Our volunteers are one of our most important assets, we could not carry out our mission without them.  We hope that your time with us will be meaningful to you as we all learn and grow to build a stronger community. Please allow ten (10) business days for a reply after submission.

Please note: This form is for youth between the ages of 14 and 17 years of age, only.

Sign in to Google to save your progress. Learn more
Contact Information
Title (Mr., Mrs., Ms.)
Last Name *
First Name *
Middle Initial
Street Address, Apt # *
City, State *
Zip Code *
Telephone Number *
Email Address *
Requires a unique email address for each volunteer to utilize our scheduling site (Please do not use parents' email).
Date of birth (enter as mm/dd/yyyy - e.g.  12/31/2014) *
Additional Information
School
Are you volunteering to meet a community/school service requirement? *
If you answered yes above, how many community/school service hours are required?
List any applicable affiliations (Church, clubs, or other groups)
Emergency Contact - Last Name *
Emergency Contact-First Name *
Emergency Contact-Telephone Number *
Emergency Contact-Email Address
Volunteer Experience & Special Skills or Qualifications
Other Volunteer Experience
Describe any past or other volunteer experience you would like us to know about.
Other Languages
List the languages that you speak or write fluently.  
How Did You Hear About Us
Check all that apply
WORTHINGTON RESOURCE PANTRY YOUTH RELEASES AND AGREEMENTS
Please read each release and agreement noted below then enter today's date, the parent name and the youth name in the signature field.  Releases and agreements must be completed by parent and youth prior to volunteering.

The Worthington Resource Pantry Youth Policy and other information appear on the page following this application.
1. Youth Waiver and Release Of Liability Form
Parent:  I give permission for my child to serve as a youth volunteer with the Worthington Resource Pantry (WRP).  I understand that my child (if under 18) must work alongside other qualified WRP volunteers of at least 18 years of age at all times, and I give the adult volunteers permission to supervise and direct my child’s activities.  

Youth:  I will abide by the rules and policies of the Worthington Resource Pantry (WRP).  Worthington Resource Pantry is not liable for any injuries, damages, losses, judgments, costs, or expenses which I might suffer or sustain in connection with the performance of my volunteer activities with the WRP.

Parent & Youth:  I hereby release, indemnify and hold harmless the Worthington Resource Pantry, its directors, officers, agents, employees and volunteers and their heirs, successors, and personal representatives from and against liability
2. Release for Use of Name, Likeness, Quote, and Photograph
I provide WRP and other such persons affiliated with WRP the absolute right and permission to use my name, likeness, quote(s), and photograph(s) made of or collected from me, in whole or in part, throughout the world for the purpose of advertising, publicity, or any other lawful purpose, in any media now known or ever developed.  I agree that I will not hold WRP or anyone who deserves permission from either of them, responsible for any liability resulting from the use of my name, likeness, quote(s), and photograph(s) in accordance with these terms.  
Worthington Resource Pantry Volunteer Agreement and Signature
I to agree abide by the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

I agree to watch the volunteer orientation video before my first shift: https://www.youtube.com/watch?v=InSAkM98poo

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.


Date *
MM
/
DD
/
YYYY
Parent Signature *
Enter your full name as indication that you have accurately and truthfully agreed to Release 1, Release 2 and the Volunteer Agreement listed above for your youth.
Youth Signature *
Enter your full name as indication that you have accurately and truthfully agreed to Release 1, Release 2 and the Volunteer Agreement listed above.
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms