Form Center

2. 
3. City of Yachats
   441 Highway 101 N
   PO Box 345
   Yachats, OR 97498
4. Phone: 541-547-3565
   Fax: 541-547-3063

6. Thank you for your interest in volunteering for City of Yachats. We look forward to partnerships with volunteers to enable us to effectively serve the citizens of our community. In order to ensure the safety of our volunteers and protect the interests of City of Yachats, we require potential volunteers to complete this questionnaire form and participate in a background check. Thank you for volunteering.
8. First Name*
9. Last Name*
11. Address*
13. City
14. State
15. Zip Code
17. Daytime Phone*
18. Evening Phone
19. Email*
23. Volunteer Activity
25. Please describe the type of volunteer work you are interested in performing or activity/event you wish to volunteer for.*
27. Please list the date(s) or range of dates for which you would like to volunteer
    "Any time” can be a stated date range.
29. Statement of Interest or Related Experience for Commissions & Committees
    Please provide a short narrative about why you chose to apply for this particular committee or commission. You may attach a document below, if needed.
31. Upload document, if needed
35. References
    Please list two references that are not related to you and that have knowledge of your relevant experience for the type of volunteer activity you are interested in.
37. Reference 1
39. First Name*
40. Last Name*
42. Address
44. City
45. State
46. Zip Code
48. Phone Number
49. Relationship*
50. Years Known*
52. Reference 2
54. First Name*
55. Last Name*
57. Address
59. City
60. State
61. Zip Code
63. Phone Number
64. Relationship*
65. Years Known*
67. Emergency Information
    Name and contact information for the person(s) to reach in the event of an emergency.
69. Name
70. Phone Number
71. Relationship
73. Name
74. Phone Number
75. Relationship

77. I understand and agree to the following:

    • I will keep all issues pertaining to city business confidential
    • I may be subject to background and motor vehicle record checks.
    • I will adhere by Oregon Occupational Safety and Health Division (OR-OSHA) safety standards and training I am provided.
    • I have read and understand the Volunteer Policy.
    
    I hereby certify that the facts set forth in this volunteer registration are true to the best of my knowledge. I agree that if the information given in my registration, resume, or any other materials, or during any interview, is found to be false in any way, it shall be considered sufficient cause for denial of volunteer status. 
    
    I understand that City of Yachats is not obligated to appoint me to a volunteer position and that nothing contained in the volunteer registration form is intended to create a contract between City of Yachats and me. In addition to the above items, I agree to comply with the policies, rules, regulations, and procedures of City of Yachats, which I understand may change at any time and I understand that my volunteer status can be terminated with or without cause or notice, at any time, at the option of either me or City of Yachats.
79. Signature
80. Date
    Date
82. Required for all Minors: Parent or Guardian's Authorization for Medical Care & Consent to Agreement

    I PARENT/GUARDIAN as parent or legal guardian, hereby grant permission for MINOR to do volunteer work for City of Yachats. In the event of an emergency, accident, or illness, I authorize City of Yachats and its employees to administer emergency medical care to my child and/or, if deemed necessary, to secure emergency medical services and incur expenses for which I will be responsible for payment. My signature in the following hereby represents that I have read, understand, and to this agreement. 

84. Parent/Guardian
85. Minor
87. Signature
88. Date
    Date
90. Version 2019-04-16
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92. 1. Receive an email copy of this form.
93. Email address

    This field is not part of the form submission.

94. Submit

* indicates a required field