Volunteer Driver

Canopy of Neighbors Volunteer Application

Application Date: _____________

Volunteer Name: _____________________________________

Home Address: _______________________________________ Number/Street

_____________________________________ City/State/Zip

Mailing Address (If different from home address): _______________________________________________________ Number/Street

_____________________________________________________ City/State/Zip

Email address: _________________________________

Home Telephone: _______________________________

Mobile Telephone: ______________________________

Work Telephone: _______________________________

Volunteer Emergency Contact(s) Information:

Emergency Contact Name:

Emergency Contact Phone: _________________________________________

Emergency Contact Address: _____________________________________Number/Street

_______________________________________ City/State/Zip

Relationship to Emergency Contact: _______________________

Are you volunteering to drive Canopy members? Yes___ No___

If yes, by signing this form you understand you are required to maintain both collision and general liability coverage on any vehicle used to transport a member as required by New York State law. You are required to notify Canopy if there is any lapse in coverage.

Are you volunteering to fulfill a school or community service requirement?

Yes___ No ___

If yes, please specify the number of hours required to fulfill your commitment. ______________

Please indicate skills and/or areas of work that will enable us to match you with volunteer opportunities:

______________________________________________________________________

References

References are encouraged in order to volunteer at Canopy of Neighbors. Please list your reference below. Your reference should include someone not related to you.

Reference Name:

Home Address: ______________________________Street

_____________________________________ City/State/Zip

Email address: _________________________________

Phone: _______________________________

VOLUNTEER Signature: __________________________________

Date: ________________

Thank you for completing our application. We look forward to discussing volunteer opportunities

at Canopy of Neighbors with you!