Volunteer

First Name*

Last Name*

Middle Initial

Home Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

Email Address (work or personal)*

Emergency Contact Name, Relationship and Phone Number*

How did you hear about this opportunity?*

How often would you like to volunteer at The Arc of the Quad Cities Area?*

What skill do you have that will help you volunteer with us?*

Authorization to Release Information*

I authorize The Arc of the Quad Cities Area to use, reproduce and/or publish my image, likeness without compensation. I understand that this material could be used in The Arc of the Quad Cities Area publications.

Yes
No

Commitment to Confidentiality*

I agree to The Arc of the Quad Cities Area’s commitment to confidentiality. I am not authorized to take pictures of individuals served by The Arc of the Quad Cities Area and will follow confidentiality policies and procedures. If for some reason, these policies cannot be followed, The Arc reserved the right to terminate this agreement.

I Agree

Injury Release*

I recognize this is a voluntary assignment with no compensation. I hold harmless The Arc of the Quad Cities Area from any injury sustained in my volunteer assignment.

Yes

PLEASE READ*

The confidential information on this form will help determine the most satisfying and appropriate volunteer service for you. This form does not commit you to volunteering for The Arc of the Quad Cities Area.

I Understand

I CERTIFY THAT TO THE BEST OF MY ABILITY THAT THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE.*

I understand that typing my name in the following field acts as my signature for the form.

WHO WE ARE

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Being kind to the world that sustains and nurtures us is sensible as well as kind.

Home & Facility Support

Social, Fun & Recreational Activities

Adopt‑a‑Group‑Home Opportunities

Share Your Skills & Talents

Special Event Volunteering

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Have Questions or Want to Get Involved?

Get involved by filling out the following forms:

Organization Volunteer Sign Up

Individual Volunteer Sign Up

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