Volunteer Application

Developmental Disabilities of Clark County appreciates the volunteerism and compassion of our community! If you have time to share, please let us know below!

Date*
MM slash DD slash YYYY
Name*
First Last
Current Age*
You must be 18 or over to volunteer.
Address*
Street Address City State ZIP Code
Cell Phone*
Email*
Placement and Goals for Your Volunteering Experience
I am interested in the following volunteer opportunity:*
Please read service descriptions. Some have requirements you must meet in order to serve in those areas. (You may check more than one, however you may only be assigned to one.)
- Social Work Practicum/Internship
- Wittenberg Work Study or 50/50 student
How many hours per week would you like to serve?*
If volunteering to fulfill a school requirement, on what date must your hours must be completed?
MM slash DD slash YYYY
Please list any experience you have had working with people who are developmentally disabled. (none is required to volunteer)*
Do you know anyone employed by Developmental Disabilities of Clark County? If so, who?
Emergency Information
In the event of an emergency, please list who we should call and any information that should be passed on to first responders.
Person We Should Contact in Case of Emergency*
First Last
Phone Number of Your Emergency Contact*
Agreement and Waiver
I swear that all the information in this application is true. I understand and give permission for a variety of background checks. I understand that as a volunteer of Developmental Disabilities of Clark County, I am not included in insurance coverage. I hereby waive on behalf of myself and my executors, administrators and assigns, all claims for damage or loss to my person and property which my be caused by an act or failure to act of Developmental Disabilities of Clark County, its officers, agents or employees. I assume the risk for all hazardous conditions in and about the premises and waive any and all specific notice of the existence of such conditions. I give permission for photos of me to be used in publicity materials for Developmental Disabilities of Clark County. By typing my name below, this constitutes my legal signature and agreement to this waiver.*
Date Signed*
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

Volunteer Application

Placement and Goals for Your Volunteering Experience

Emergency Information

Agreement and Waiver