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AmeriCorps Seniors RSVP of Northern Cook County & Northern DuPage County
Basic Information
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Address
Demographics and Personal Information
Other Information
List your skills
If you have already started volunteering, please fill out these questions below. If not, continue to the insurance section.
Volunteering Information
Insurance Statement for Driving an Automobile To/From Volunteer Site I Understand That
We are required to provide you with complimentary supplemental liability auto insurance protection while driving directly to and from and while you are participating at your volunteer site. This insurance requires the name of a beneficary.
Beneficiary Information
Emergency Contact Information
I, the undersigned, intending to be legally bound, give permission to AmeriCorps Seniors RSVP and HandsOn Suburban Chicago to use photographs and/or videotapes of me with or without my name, taken while I am participating in AmeriCorps Seniors RSVP or HandsOn Suburban Chicago activities, for the purpose of publicity, illustration, advertising, and Web content for promoting the programs of AmeriCorps Seniors RSVP or HandsOn Suburban Chicago, and as a condition of my participation in said programs, I hereby waive any and all rights to claims for loss or damages incurred in connection with the use of said photographs and/or videotapes. I agree that all information I have entered is current and correct. I certify I volunteer my services through AmeriCorps Seniors RSVP of Northern Cook and Northern DuPage Counties and understand that I am not an employee of RSVP. Within the past 10 years, I have not been arrested or convicted of, nor am I under pending indictment for any crimes, felonies, or misdemeanors.
Electronic Signature*
Writing your name in the field below signifies that you agree with the insurance, photo and enrollment statements above.
