2. Volunteer for the City of Kennewick Parks & Recreation Department!

   2901 Southridge Boulevard, Kennewick, WA 99338

   PHONE: 509-585-4293   E-MAIL: recreation@ci.kennewick.wa.us

4. Full Name:*
6. Age*
7. Birthdate*
8. Gender

   1. Male
   2. Female
10. Address*
12. City*
13. State*
14. Zip Code*
16. Email Address*
18. Cell Number*
19. Alternate Number
21. Day Availability*

    1. Su
    2. M
    3. T
    4. W
    5. Th
    6. F
    7. Sa
22. Time Availability*

    1. AM
    2. PM
    3. On-going
    4. On-call
24. Emergency Contact Name #1:*
25. Phone Number:*
27. Emergency Contact #2:*
28. Phone Number:*
30. Do you currently volunteer?*

    1. Yes

    1. No
31. If "Yes", where do you volunteer?
33. List the type of volunteer work you perform:
35. Name of Volunteer Supervisor you report to:
36. Supervisor's Day Phone:
38. Volunteer Interests:*

    1. Youth Sports
    2. Youth Activities
    3. Special Event(s)

    1. Day Camp
    2. Office Work/Clerical
    3. Kitchen Assistance

    1. Newsletter folding/Mail prep
    2. Adult or Senior Programs
    3. Other
40. List any skills, coaching/playing experience that you may have:*

    For example: working with the public, teaching a class, computer skills, foreign languages, coaching and/or playing a sport, event planning, kitchen experience, etc.

42. Have you been convicted of a crime in the last 10 years?*

    1. Yes

    1. No
44. Please list two personal references who can speak knowledgeably of your ability to volunteer:
46. Name*
47. Phone Number*
48. Occupation*
49. Years Known*
51. Name*
52. Phone Number*
53. Occupation*
54. Years Known*

56. I understand that all information on this form is voluntarily supplied and may be disclosed for volunteerism purposes only. I hereby volunteer my services and understand that I am not a paid employee of the Kennewick Parks & Recreation Department or the City of Kennewick. I agree to keep all information about clients, volunteers, or other individuals, obtained while volunteering, confidential. I realize and understand that there are certain risks inherent in the activity for which I am volunteering for. Also, I agree to hold the City of Kennewick, Pasco, Richland, all school districts, and any employee or volunteer associated with the program I am involved in harmless from, and indemnify them for, any damage or loss arising as a result of my (my child's) participation. I give permission to have my (my child's) photo taken during this program used for publicity purposes by the City of Kennewick. I hereby give my consent tor emergency medical treatment. I understand that this is to prevent undue delay and assure prompt treatment and that only a licensed healthcare provider will be engaged for such emergency. 

58. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
60. Electronic Signature*
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field