<p> Of the Midlands</p><p>BOYS & GIRLS CLUB VOLUNTEER INFORMATION FORM</p><p>For Internal Use Only Date Received:____/____/____ Date of Background Check:____/____/____ Result: Recommended or Not Recommended Personal Information – please print or type Name______Home Phone: ______Address______Work Phone: ______Date of Birth: __/__/__ SSN:____-___-____ Email Address: ______Emergency Contact______Phone:______Present Occupation______Academic/Professional Credentials______Special Skills______Volunteer Experience: ____Yes ___No If yes, please list______Clubs – please write in the following club where you wish to volunteer</p><p>Interest Inventory What types of volunteer opportunities are you interested in? ( circle all that apply) tutoring / computer lab instructor / sports / arts / office & clerical work / other______</p><p>Availability What days and times will you be available to volunteer? Times are available 2pm-6:30pm during the school year and 7:30am-6:30pm during the summer. Hours at the service center are 8:30am- 5:00pm. Monday Tuesday Wednesday Thursday Friday Times Available We check all references. Please list two references (not relatives) we may contact: Name______Ph#______Relationship______Name______Ph#______Relationship______</p>