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Williamsport Branch YMCA Volunteer Application

Personal Information
Name ___________________________________ Birth Date ______________ Gender _______________
Address _______________________________ City ________________ State _______Zip ______________
E-mail _____________________________________ Home Phone ________________________
Volunteer Service Required? Yes/No Number hours needed? ________________
What volunteer opportunity (ies) are you interested in? (List can be found at
the front desk or online)
Please indicate the days and hours you are available:
Monday Tuesday Wednesday Thursday Friday

Saturday Sunday

Have you ever been convicted of a crime? If so, please explain.
Why do you want to volunteer in this area? (Be Specific)
Are you a registered sex offender? Yes/No
Are you able to perform the essential functions of the job for which you are
applying with or without reasonable accommodations? Yes/No
Emergency Contact Information
Name ________________________________________________ Relationship __________________________
Address _____________________________ City _________________ State ________ Zip ______________
E-mail ______________________________________ Home Phone ____________________

Volunteer Code of Ethics and Policies

1. Smoking or use of tobacco products in the YMCA programs or on YMCA
property is prohibited.
2. Using, possessing, or being under the influence of alcohol or illegal drugs


3. Any form of abuse of children WILL NOT BE TOLERATED including:
Physical Abuse strike, spank, shake, or slap
Verbal Abuse- humiliate, degrade, or threaten
Sexual Abuse including inappropriate touching and exposure
Mental Abuse (Self Esteem)- comparison, or criticism
4. Volunteers must treat everyone of all races, religions, and cultures with
respect and consideration.
5. Volunteers must use positive techniques of guidance, including positive
reinforcement and encouragement rather than competition, comparison,
or criticism.
6. Volunteers shall abstain from humiliating or frightening discipline
7. Volunteers shall not use profanity in the presence of children or parents
8. Volunteers shall refrain from intimate displays of affection toward
others in the presence of children, parents, and staff.
9. Monetary and expensive gifts to volunteers are prohibited.
10. Volunteers must be free of physical and psychological conditions that
might adversely affect others.
11. Volunteers will do everything in their power to avoid being put in a
situation where they are alone with a (YMCA) child other than their own.
12. Volunteers will portray a positive role model for youth by maintaining
an attitude of respect, loyalty, patience, integrity, courtesy, tact and

_______ I certify that the statements made by me in this application are true,
complete and correct to the best of my knowledge and belief, and are made in
good faith. I understand that falsification, misrepresentation, or omission of
facts called for by this application could result in immediate dismissal as a
_______ I understand that the volunteer duties I choose may require me to
obtain a criminal record check, child abuse clearance and FBI clearance before
starting the volunteer opportunity.
_______ I authorize the Williamsport YMCA the right to contact and obtain
information from all references, employers, educational institutions, and law
enforcement agencies, and otherwise verify the accuracy of the information
contained in this application.
_______ If I become a volunteer, I understand that I am free to resign at any
time and my volunteer employer reserves the same right to end my volunteer
_______ I understand and agree that this application does not constitute a
contract for volunteer time for any definite duration. The length time hinges
on the quality of the job that I do as a volunteer.
I understand that any violation of the Volunteer Code of Ethics and Policies
may be grounds for removal as a volunteer. I have been informed of the
YMCAs position regarding criminal background checks and child abuse. Being
fully aware of the matters contained therein I still desire consideration as a
volunteer for the YMCA.
Volunteers Signature



Reviewed by______________________
Approved Y/N
Comments: _____________________________________________________________