KidSight Volunteer Application

Volunteer Contact Information

Name*

First Last

Preferred Name

Birthdate*

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Work/Volunteer History

Are you:*

Employed
Retired
Student

Do you live in Missouri?*

Yes
No

Are you a Lions Club member? If yes, which Club?*

List any language, other than English, that you speak fluently:

What skills and interest do you have relating to KidSight?*

Have you ever volunteered with us or another organization? Tell us about your experience below:*

Volunteer Position

Which position are you applying for? Check one.*

For more information about these positions, please visit the volunteer page.

Volunteer Screening Assistant
Volunteer Screener
Liaison
Logistics Coordinator

References

Please list two references: it can be a friend, employer, coworker, fellow organization member, etc.

Reference #1 Name*

First Last

Reference #1 Phone*

Reference #2 Name*

First Last

Reference #2 Phone*

KidSight Volunteer Agreement*

I agree to the volunteer policies outlined below.

I agree not to consume or use tobacco products on any volunteer assignment.

I agree not to consume, use, possess, or be under the influence of any drug or alcohol products on any
volunteer work assignment.

I understand that any pattern of conduct that would tend to disrupt, diminish or otherwise jeopardize
public/client trust KidSight will result in dismissal.

I understand that my volunteer assignment with KidSight may be terminated at any time.

I understand my involvement with KidSight may include coverage in the media. I approve the use of my
likeness, voice, photograph, words and any other creative work without payment or consideration by the
media or KidSight.

I have read, understand and agree to the protocols outlined in the KidSight Volunteer Handbook.

Waiver of Liability*

I agree.

In consideration of KidSight allowing me to participate in volunteer programs, and being aware of the
possible injuries that could occur as a result of that participation, I on behalf of myself release KidSight
employees, agents, instructors from any and all injuries and damages whatsoever from participating in
events.

I, my heirs and representative, agree to indemnify, save and hold harmless KidSight, its officials,
employees, and agents from any and all claims made by me or my insurer for injuries or damages
related to these events.

I certify that all information provided on this application and during the interview process is true and
complete. I understand that falsification or significant omissions of any information may be considered
justification for non-acceptance or dismissal if discovered at a later date and that appointment to a
volunteer position may be contingent upon the completion and review of a criminal background check.

Type your name below to e-sign your application*

CAPTCHA