Community Renewal International

Community Renewal International Volunteer Information Form

Name:

Address:		City:
State:		Zip:
Phone Numbers (home):		(cell):
Can we call you at work?		Work number:
Email:		Birthday:

Please complete the following information

Work Experiences

Position Held	Responsiblities	Date

Educational Experiences: List diplomas, certificates or areas of expertise

Life Experiences: Describe your interests, abilities, skills and/or hobbies

Volunteer Experiences: For example, at school, in your faith community, neighborhood, etc.

Organization	Brief description of role

Worship Affiliation (if any):

What would you like to gain from your work with CRI:

Personal References: name, address and phone number of someone not related to you

I solemnly swear, to the best of my knowledge and belief that the information presented in this application is true and complete and that I know of no impediment that would render me unfit to work with children or youth. I will keep confidential any information I learn about individuals or families in the course of my volunteer work.

I give permission to CRI to use photographs or videos of me obtained while participating in events or activities.

I hereby release, discharge, exonerate and absolve CRI, its staff, Board, volunteers, representatives, agents and successors from any and all responsibility and/or claims, and causes of action of any types whatsoever arising out of or in any way connected with participation in activities or programs.

Initial here:

Verification Number: 41136 Type Verification Number:

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