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RSVP OF SOUTH WESTERN CT

VOLUNTEER REGISTRATION FORM
 Tele:   (203) 899 2443         Fax:    (203) 899 2430
98 South Main St. Norwalk- CT 06854
 

Name:

 

Date:

 

Address: (city, state, zip)
 

Phone:

 

Birthday:

 

IN CASE OF EMERGENCY – PLEASE NOTIFY

Name:

 

Phone:

 

Address: (city, state, zip)
 

Relationship:

 

INSURANCE INFORMATION
 RSVP provides a supplemental insurance package for volunteers while participating in an activity sponsored by RSVP. Coverage includes auto liability, accident liability, and life insurance.  
I designate the Beneficiary of my RSVP life insurance to be:

Name of Beneficiary:

  

Relationship:

   

Address:

  

  

Phone:  

Driver’s License Number

 

Exp. Date

 

I, the Volunteer, understand that if I use my personal automobile in my volunteer service, I will arrange to keep in effect automobile liability insurance equal to the minimum limits required by the State of Connecticut.

 

MISCELLANEOUS
What physical conditions should be considered in arranging your volunteer assignments?
 
Previous experience & education:
 
How did you hear about RSVP?
 
TIMEFRAMES AVAILABLE
What times are you available to volunteer?  
How many hours per week do you want to volunteer?  
What days are you interested in volunteering?  
What towns do you want to volunteer in?  

 

CHECK YOUR AREAS OF INTEREST AND SKILLS

ARTS

ENVIRONMENT/OUTDOORS

LEISURE

___Fine Arts

___Conservation

___Crafts/Sewing

___Photography

___Gardening

___Knitting

 

 

 

 

 

 

BUSINESS

COMMUNITY SERVICE

HEALTH

___Administrative

___Animal Rescue

___Bloodmobile/pressure

___Clerical

___Boards/Committees

___Clinics/Hospitals

___Tax Preparation

___Emergency Preparedness

___Nutrition

     ___Mailing

 

___Counseling

 

 

 

EDUCATION

MISCELLANEOUS

OTHER

___Adult Literacy

___Phone Calls

 

___Child Literacy/ Story Reading

___Research

___________________________

___English as a Second Language

___ Writing/Editing

 

___Library Work

___Short-term Assignments

___________________________

___Mentoring

___Lecture/Presentations

 

___

___

___________________________

What Age Groups Interest You?

___Infants

___Middle School Age

___Adults

___Preschool Age

___High School Age

___Seniors

___Elementary Age

 

 

 

Signatures
I understand that I am not an employee of the RSVP program, or the volunteer worksite to which I am assigned.

Volunteer’s Signature _______________________________ Date ___________
RSVP Director Signature _______________________________ Date ___________

 

98 South Main Street, Norwalk, Connecticut 06854 (203) 899-2442
RSVP is sponsored by Norwalk Economic Opportunity Now, Inc. Corporation for National and Community Service and the United Way of Norwalk-Wilton