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Volunteer Enrollment
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(mm/dd/yyyy)
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First Name
Last Name


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country



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Please list 1 reference other than relatives.
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(Name, Relationship, Phone & Email and Year Acquainted)
Volunteer Interests
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*Due to BOAA policy, we cannot fulfill court-ordered Community Service Hours.
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(Including any felonies or misdemeanors) BOAA policy prohibits any type of criminal history.

 


Your ID will be checked and/or copied upon volunteer orientation for all BOAA Programs.

I acknowledge and agree that all information provided herin is accurate and try and hereby authorize Brownsburg Older Adult Alliance, LLC (BOAA) to verify such information, contact references, and conduct a criminal background check. I understand I will not be paid for my services, as this is strictly volunteer work. I have read and understand the above statements. Submission of the form is proof of my agreement.

BOAA is an equal opportunity volunteer organization. All volunteer applicants are considered without regard to race, religion, sex, age, disability, national origin, or any other legally protected status.