Volunteer | Roane County Anti-Drug Coalition

Name*

First Last

Date of Birth

DD/MM/YY

Address*

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

Phone*

Cell Phone*

Email*

Are you a Veteran?*

Yes
No

Physical/Medical Limitations*

(Optional) Gender:

Male
Female

(Optional) Race/ Ethnic Background

White
Asian
African-American
Hispanic/Latino
American Indian/Alaska Native
Pacific Islander
Other

Have you ever been convicted of a criminal offense or misdemeanor?*

Yes
No

If Yes, please attach an explanation of charges, date of offense, and status of the charges on a separate sheet to be included with this application.*

Employment/Volunteer Experience*

Special Skills/Interests/Languages*

Available Days*

Monday
Tuesday
Wednesday
Thursday
Friday

Available Hours*

Morning
Afternoon

What size t-shirt do you wear?*

As a volunteer of RSVP, you will be covered by accident and personal liability insurance plus a small death benefit while performing volunteer duties. This coverage is automatic and free of cost to you as long as you are an active, enrolled member of RSVP. Please provide the following information.

Emergency Contact*

First Last

Phone*

Beneficiary for RSVP Supplemental Accident Insurance:

Name*

First Last

Relationship*

Address*

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

Phone*

Please indicate if RSVP may have permission to use your likeness?

I hereby grant Roane County Anti-Drug Coalition RSVP permission to use my likeness in photograph(s)/video(s) in any and all of its publications or on the world wide web, whether now known or hereafter existing, controlled by RSVP of RCADC in perpetuity. I will make no monetary or other claim against RSVP of RCADC for the use of these photograph(s)/video(s).
I do not give permission to use my likeness in photograph(s)/video(s) to RCADC RSVP.

Certifications

By signing below, I acknowledge that I have read and understand the following statements:

Select from the following:*

I hereby state that I am under 55 years of age and offer my services as a volunteer for the RCADC Retired Senior Volunteer Program. I understand that I am not an employee of the RSVP Project, RCADC, the volunteer station or the Federal Government and agree to serve without compensation.
I hereby state that I am 55 years of age or older and offer my services as a volunteer for the RCADC Retired Senior Volunteer Program. I understand that I am not an employee of the RSVP Project, RCADC, the volunteer station or the Federal Government and agree to serve without compensation.

I understand that in my capacity as an RSVP volunteer I may encounter confidential information. I agree to protect this information to the best of my ability and not to disclose it during or after my service as a volunteer has ended.
I understand that if I use my personal automobile in my volunteer service, I will arrange to keep in effect automobile liability insurance equal or greater to the minimum requirements of the state of Tennessee and a valid driver's license to meet Tennessee state requirements.

Signature

Equal Employment Agency - RCADC RSVP is an equal opportunity agency. Enrollment is done without regard to race, color, religion, national origin, sex, age or disability. RSVP provides reasonable accommodations to the known disabilities of individuals in compliance with the Americans with Disabilities Act. For accommodation information or if you need special accommodations to complete the application process, please contact RCADC RSVP at (865) 224-0205.

Volunteer Form

Beneficiary for RSVP Supplemental Accident Insurance:

Certifications

Section Break