Volunteer Registration – Intensive Therapeutics

Name *

First

Last *

Last

Date of Birth

Gender

Home Phone

Cell Phone

Phone Back-up

Email *

Address *

Address Line 2

City *

State *

Postal Code *

Country

Availability

Other

Special Skills

Previous Volunteer Experience

Summary of special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.

Dates/Times You Are Available

Summary of your previous volunteer experience

Person to Notify in Case of Emergency

Name *

First

Last *

Last

Address *

Address Line 2

City *

State *

Postal Code *

Country

Home Phone

Cell Phone

Work Phone

Background Check

Has a recent background check (within 6 months) been completed?

Yes

No

Please submit a copy with your completed application.

Please pursue getting a volunteer background check completed. Each volunteer is responsible for providing their own background check prior to volunteering. Call: 973-771-1582 if assistance is needed.

Agreement and Signature

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. *

Yes

No

Please confirm below:

Our Policy

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Thank you for completing this application form and for your interest in volunteering with us.