Red Cross Club Volunteer Registration Form

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Red Cross Club Volunteer Registration Form

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Volunteer Application Form Please type info requested; fields with an * are mandatory

* First Name

Middle Initial

* Last Name

* Home Address

* City

* State

* Zip

* Home Phone

Cell Phone

* Email

* School

* Graduation Year

Red Cross Club T-Shirts

* Red Cross Club T-Shirt (optional) Size:

Quantity
Shirts are $6.00 per shirt. Payment is due when submitting your registration. Make Checks payable to the American Red Cross.

Emergency Contact Information & Medical Authorization

* Name of Emergency Contact

* Relationship

* Phone #

Other Phone

* Date of Birth

* Medical Insurance Plan

* Subscriber Name

* Policy No.

Statistical Information (Optional)
This unit of the American Red Cross, in recognition of its responsibility to its paid and volunteer staff and the community it serves, reaffirms its policy to assure fair and equal treatment in all of its employment practices, for all persons. We will not discriminate on the basis of race, color, religion, sex, age, national origin, disability, military service, ancestry, marital status, sexual orientation, arrest and court record, nor against any qualified disabled veteran, veteran of the vietnam era or other protected categories. The following information is required solely to determine the diversity of Red Cross volunteers. Completion is optional; however, it would be most helpful to us as we monitor the complete record of our program.

Gender

Male

Female

Race

In order to complete your registration as a Red Cross Club Youth Volunteer, you MUST download the attached form and have a parent or legal guardian sign it and turn the last signed page only into your Red Cross Club Advisor. Your application will be approved ONLY upon receipt of parental/guardian consent.