YMCA of Greater Erie

Name*
First Last
Email*
Phone*
Address*
Street Address City State ZIP Code
Date of Birth*
MM slash DD slash YYYY
Length of Residence in Pennsylvania*

Please specify in years and months
How did you hear about this volunteer opportunity?
Community Service Requirement?
- Yes
- No
If yes, number of hours needed?
Deadline to complete hours?
Name of school/agency/government body requiring community service?
At what YMCA of Greater Erie branch would you like to volunteer?
Please select the times (s) you are available:*
- Monday Morning
- Monday Afternoon/Evening
- Tuesday Morning
- Tuesday Afternoon/Evening
- Wednesday Morning
- Wednesday Afternoon/Evening
- Thursday Morning
- Thursday Afternoon/Evening
- Friday Morning
- Friday Afternoon/Evening
- Weekend Event
- Other
Gender*
- Male
- Female
- Prefer not to disclose
The Y collects demographic information for grant reporting purposes only.
Age*
- Under 18
- 18-24
- 25-30
- 31-40
- 41-50
- 51-64
- 65+
The Y collects demographic information for grant reporting purposes only.
Ethnicity*
- American Indian
- Asian / Pacific Islander
- Black / African American
- Hispanic
- White
The Y collects demographic information for grant reporting purposes only.
Are you a YMCA of Greater Erie member?
- Yes
- No
Emergency Contact*

Full Name
Emergency Contact Phone*
If under the age of 18, Parent/Guardian signature for consent to treat in case of emergency:
RELEASE AND WAIVER OF LIABILITY*
I hereby accept any and all responsibility for, and assume the risk of any and all injury or damage to my person that might arise directly or indirectly as a result of, and or participation as a volunteer for the YMCA of Greater Erie. I hereby expressly release, discharge and hold harmless from any liability whatsoever the YMCA of Greater Erie, the various branches and subdivisions thereof, and all employees and volunteers in their capacities as representatives of the YMCA of Greater Erie.
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RELEASE AND WAIVER OF LIABILITY (old)
- I hereby accept any and all responsibility for, and assume the risk of any and all injury or damage to my person that might arise directly or indirectly as a result of, and or participation as a volunteer for the YMCA of Greater Erie. I hereby expressly release, discharge and hold harmless from any liability whatsoever the YMCA of Greater Erie, the various branches and subdivisions thereof, and all employees and volunteers in their capacities as representatives of the YMCA of Greater Erie.
Signature*

Volunteer Application