Hale Kau Kau Volunteer Participation Form

25 W. Lipoa St., Kihei HI 96753

Information

Name

First Name*

Last Name*

Address

Street 1*

Street 2

City*

State*

Zip*

Phone

Required* --

E-mail

Required*

Date of Birth

mm/dd/year //

*Must be 18 years or older to work in kitchen unless approved by Program Director

Emergency Contact

First Name*

Last Name*

Emergency Contact Phone

Required* --

Emergency Contact Email

7. I would like to volunteer in the following areas:	Required*	Categories: Kitchen; Driver; Office; Special Events; Other: If volunteering for driver, I understand and agree that I will need to have a valid driver's license and will provide a copy to Hale Kau Kau, and I will drive my own car. I agree to have $100,000/$300,000 in liability coverage and my insurance will respond/pay in the event of an accident.
8. Do you have any special talents that you would be interested in sharing with the Hale Kau Kau Program? i.e. special events, graphic design, photography, entertainment, etc.?
9. Availability-Please note days and time you are available to volunteer. Kitchen schedules are 2:30 pm to 6:30 pm Monday-Friday. 1:30 pm to 5:30 pm Sat-Sun. Driver's pick up schedules are 4:00 pm daily.	Required*	I would like to commit to a regular day and time, Yes or No. I cannot commit now but would like to be a substitute, Yes or No. I would be interested in assisting with occasional office work, Yes or No.

Submission

	The information on this form is true and complete. If accepted as a volunteer, any misstatement or omission of fact on this form may result in suspension of my services. I grant permission to check my background and reference and release the parish, the diocese and all diocesan locations from any and all liability that may result. I further understand that all persons who will have contact with children or vulnerable adults are require to comply with Diocesan Safe Environment policies and procedures and are required to undergo a state and federal criminal background check.
Signature	Required*	Signature: Date: Signature: (Parent or guardian must sign if applicant is under 18 years of age) Date:
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