Volunteer Service Agreement for Opal Foundation "*" indicates required fields Step 1 of 3 33% Application Type* Individual Group Name of Volunteer First Last U.S Citizen or Permanent Resident* Yes No List Visa Type Name of Group Name of Group Contact First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address Home PhoneMobile PhoneAge* Under 15 15-18 19-25 26-35 36-54 55 and Older Ethnicity & RacePlease report both ethnicity and race and tell us if you are a veteran or have a disability. Multiracial respondents may select two or more races. This information will inform our understanding of diversity and inclusion among the volunteer force in the natural and cultural resource areas. Ethnicity Hispanic or Latino Not Hispanic or Latino Race American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Asian White Black or African American Are you a Veteran? Yes No Do you have Disability? Yes No Physical LimitationsPlease provide a brief description of any physical limitations which may limit your participation in any volunteer activities.EMERGENCY CONTACT INFORMATIONContact Name First Last Contact PhoneContact Email Contract Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State PARENTAL CONSENT FOR VOLUNTEER UNDER AGE 18Parent or Legal Guardian First Last Parent or Legal Guardian Home PhoneParent or Legal Guardian MobileParent or Legal Guardian Email Parent or Legal Guardian Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Parent or Legal Guardian AffirmationI affirm that I am the parent/guardian of the above named volunteer. I understand that the OPAL Foundation volunteer program does not provide compensation, except as otherwise provided by law; and that the service will not confer on the volunteer the status of a Federal employee. I affirm I do NOT affirm Parent or Legal Guardian PermissionI give my permission for the above mentioned volunteer to participate in the specified volunteer activity. Yes No Parent/Guardian AgreementMy full name listed below represents my legal parental consent.Parent/Guardian Signature Date of Parent/Guardian Signature MM slash DD slash YYYY Volunteer AgreementI do hereby volunteer my services to assist in authorized activities performed at OPAL Foundation volunteer job sites and I agree to follow all applicable safety guidelines. My full name listed below represents my legal consent.Volunteer Signature* Agreement Date* MM slash DD slash YYYY
