Apply to Volunteer at DDRC Thank You! Your volunteer application has been successfully submitted. Apply to Become a DDRC Volunteer Contact Information First Name: Last Name: E-Mail Address: Phone: Location Address: City: State: Zip: Questions How would you like to be contacted? By Phone By E-Mail Other (Specify in Comments) Where in Jefferson County would you like to volunteer? Central North South East West Any Area Have you ever been convicted of a felony? No Yes Please describe: Do you have auto insurance? No Yes Expiration Date (dd/mm/yyyy): Insurance Company: Do you have First Aid or CPRcertification? No Yes First Aid Expiration Date (dd/mm/yyyy): CPR Expiration Date (dd/mm/yyyy): Are you presently employed? No Yes I'm Retired Please describe your occupation: Check You Interests: Being a Companion Sharing Recreational Activities Assisting with Computer Lab Becoming an Art Mentor Helping with Special Projects I Am Available: Anytime Days Evenings Weekends Emergency Contact: Emergency Contact's Name: Emergency Contact's Phone: Emergency Contact: Please include the name and phone number of a reference. The reference should (1) not be related to you and (2) have known you for at least one year. Reference Name: Reference Phone: Additional Comments: Additional comments (Skills, Hobbies, Interests, etc): Verify and Submit Please Verify your Humanity
