Milwaukie Youth Basketball Association

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* First Name:

* Last Name:

* Address:

* Home Phone:

* Cell Phone:

* Email:

* Birth Date:

* Gender:

* Emergency Contact:

* Phone Number:

* Relationship:

* Physical Limitations:

* If yes please explain:

Former Work/Occupation:

Most Recent Employer:

* Area you would like to volunteer:

* List previous volunteer experience:

* Previous Volunteer Responsibilities:

* Skills:

* Languages (list language levels - Fluent, Read, Write):

* Volunteer Availability (Number of Days per Week):

* Volunteer Availability (Days of the Week):

* Transportation (How will you get to your assignment?):

Areas of special Interest:

Why are you interested in those areas?:

AUTHORIZATION

I the undersigned, authorize the information to be obtained in connection with my volunteer application. Any person, firm or organization providing information or records in accordance with this authorization is released from any and all claims of liability for compliance. Such information will be held in confidence in accordance with the organization's guidelines.

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