V.I.P. Program
Application
Date of Application:
___________________
___ New V.I.P. ___ Returning V.I.P.
Name:
_______________________________ Home Phone Number: ________________
Address:
________________________________________________________________
City State Zip
Email Address:
______________________ Cell Phone Number: __________________
School:
____________________________ Age & Grade: ________________________
Name of Parent/Guardian:
__________________________________________________
Home Number:
________________________ Work Number: _____________________
Emergency Contact (other than
parent): _______________________________________
Relationship:
____________________________ Phone Number: __________________
Have you ever participated in
volunteer work before? _____ Yes _____ No
If yes, please explain:
______________________________________________________
________________________________________________________________________
________________________________________________________________________
Why do you want to participate in
the V.I.P. Program? ___________________________
________________________________________________________________________
How did you hear about the V.I.
P. Program? ___________________________________
Please list any skills or special
interests________________________________________
________________________________________________________________________
In a short paragraph tell us
something about yourself _____________________________
________________________________________________________________________
________________________________________________________________________