Mid-peninsula Boys and Girls Club

First Name:

Last Name:

Gender:MaleFemale

Birthdate:

If Under 18, please enter parent(s) or guardian(s) name with whom you live:

Ethnicity (optional):

Home Address:

City:

State:

Zipcode:

Email Address:

Home Phone:

Work Phone:

Cell Phone:

Do you speak other languages ie: spanish (please specify which):

Where would you like to volunteer:

San Mateo Clubhouse
DeLue Clubhouse

Please specify your program preference (multiple selections ok):

Administrative Work
Academics
Athletics
Computers / Tech

Art
Social / Games
Teens

How many hours a week would you like to volunteer:1-4 hours
5-12 hours
13 or more

Days You Are Available:

Monday
Tuesday
Wednesday

Thursday
Friday

Hours Available:

Morning: 9AM - Noon
Afternoon: Noon - 5PM
Evening: 5PM - 8PM

What is your occupation? (if student, please specify)

Name of employer or school:

If in school, what grade:

Are you volunteering as part of a corporate / community program or organization, If YES, please specify which one:

Have you volunteered with us in the past, if so, when?

Are you a parent of one of our members, if so, who?

Are you a former Boys & Girls Clubs Member, if so, where?

Have you ever been convicted of a misdemeanor or felony within the last seven years? If so, please provide a brief explanation:

Certification of Applicant

I certify that all statements made in this application are true and correct. I understand that any misstatement, misrepresentation, or omission of material fact may result in my application being rejected; or, if I have been offered a position as a volunteer, in my offer being withdrawn. I also agree to submit my Social Security Number, if required, for the purpose of a background check. I understand that my application process will be not be complele until I have been interviewed and received clearance by the Volunteer Director.

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