HandsOn Central California

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Fields marked with an asterisk (*) are required.

First Name

Last Name

Date of Birth

AmeriCorps Seniors programs are federal National Service programs are for volunteers 55 years of age or older.

Section

Home Address

Home City

Home State

Home Zip Code

Home County

Preferred Method of Communication

Contact Email

Phone Number

Mobile Phone

Optional Gender, Ethnicity and Race Identification

This is used for maintaining the records for program research or survey response, and in the production of summary descriptive statistics and analytical studies.

Providing this information is voluntary and has no impact on your application.

What gender do you identify as?

Self-Declared Gender

Ethnicity

Racial Group (pick as many as apply)

Please select the category or categories with which you most closely identify.

Are you disabled?

This field is required

Veteran Status

I am a veteran of the US Armed Forces

This field is required

I am an Active Duty Member

This field is required

I live with an immediate family member who is an Active Duty Member

This field is required

As an RSVP volunteer, you are insured for supplemental volunteer accident and personal liability while volunteering at a volunteer site. This is strictly secondary insurance at NO COST to you. Since there is a small accidental death benefit involved, you are asked to name a beneficiary.

Beneficiary Information for AmeriCorps Seniors RSVP Supplemental Insurance:

Beneficiary Name

Beneficiary Relationship

Beneficiary Address

Beneficiary Phone

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Relationship

I understand, (excluding the supplemental volunteer accident insurance provided), that my activities as a volunteer for HandsOn Central California (HOCC) are undertaken at my sole risk, and HOCC will not be liable for any claims for injuries or damages whatsoever to my person or property arising out of or connected with my actions as a RSVP volunteer. I agree to indemnify and to hold harmless HOCC for all cliams and/or liability for me or to me. I also agree that this waiver and release shall apply to my heir(s), executor(s), and administrator(s).

I understand that by agreeing to this waiver, I give permission to use my image in educational and/or public relations materials.

I volunteer my services through the HandsOnCentral California AmeriCorps Seniors RSVP Program, and I undrstand that I will be placed in a volunteer position, not a paying job. My volunteering is at my discretion and does not interfere with job search or employment.

I have carefully read this Waiver/Release, I understand its contents, and I intend to be bound by its terms.

I agree

This field is required

Cancel Submit application to serve as an AmeriCorps Seniors RSVP volunteer!

Optional Gender, Ethnicity and Race Identification

Providing this information is voluntary and has no impact on your application.

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