First Name:
Middle Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone Number:
Email:
Birthday:
Occupation:
Work Phone:
Can we call you at work?		yes no
Emergency contact:
Emergency contact's phone number:

Are you a student?
yes no
Is this community service?
yes no Do you speak a language other than English? yes no
Is there a particular type of work you are interested in?
yes no
If yes, please explain:
What days and hours are you available?
Have you previously been involved with the Shade Tree in any capacity?
yes no
Are there any special talents you would like to share with the Shade Tree?
yes no
If yes, please explain:
Have you ever been arrested?
yes no
If yes, please explain:
What activities do you like to do best?

Please provide two references:
Reference 1
Name:
Address:
Phone:
Reference 2
Name:
Address:
Phone:
Comments or other information that you would like to provide to The Shade Tree.
I certify that the statements on this application are true and correct to the best of my knowledge. I understand that any misrepresentation or omission of fact of this application may be considered as constituting grounds for denial. I further understand that any offer to work with The Shade Tree is subject to completion of a background investigation and training. I do hereby give my consent that any person, firm, or organization listed hereon is authorized to furnish to The Shade Tree personal or reference material concerning my character, present employment or any other information they so request. I further understand that I may be exposed to possible risks and harm and I agree to personally assume all risks and harm while volunteering at The Shade Tree.
Last changed September 2007