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 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
