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GBC Youth Volunteer Form
First Name
Last Name
Address
Apartment, suite, etc.
City
State
Zip/Postal Code
Home Phone Number
Cell Phone Number
Email
Birthdate
Month
January
February
March
April
May
June
July
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September
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Date
1
2
3
4
5
6
7
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9
10
11
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15
16
17
18
19
20
21
22
23
24
25
26
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28
29
30
31
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
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1925
1926
1927
1928
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1930
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1932
1933
1934
1935
1936
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1938
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1942
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1944
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1963
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1965
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1969
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1971
1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
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1991
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1993
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1995
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2000
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2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Gender
Male
Female
1. Are you at least 18 years of age?
Yes
No
2. Are you willing to attend a training course about GBC’s policies and procedures governing its youth?
Yes
No
3. Do you agree to complete the screening interview?
Yes
No
4. Have you ever been accused of, arrested for, charged with, or convicted of child abuse or molestation, or of substance abuse or distribution, or have you been involved with or connected to others involved with handling dangerous weapons?
Yes
No
5. Have you been accused, arrested, charged or convicted of any crime involving a youth?
Yes
No
6. Have you been convicted of a misdemeanor, not including driving or traffic offenses?
Yes
No
7. Have you been convicted of a felony?
Yes
No
8. Other than the above, is there any fact or circumstance involving you or your background that would call into question your being entrusted with the supervision, guidance or care of young people?
Yes
No
9. If you answered yes to questions 4, 5, 6, 7 or 8 above, please explain:
Explanation for # 4, if your answer was yes.
Explanation for # 5, if your answer was yes.
Explanation for # 6, if your answer was yes.
Explanation for # 7, if your answer was yes.
Explanation for # 8, if your answer was yes.
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