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Petersburg Ambassadors Program/Community Partner - Volunteer Application

2. Petersburg Ambassador/Community Partner Options
   -- Select One --Collegiate AmbassadorEco-Friendly AmbassadorGeneral AmbassadorHigh School AmbassadorSeasoned AmbassadorCommunity Partner

   Please select choice

3. First Name

   First Name or Participating Volunteer

4. Last Name

   Last Name of Participating Volunteer

5. Cell Number or Best Number

   Please include area code

7. Address1

8. Birthdate

10. Apartment #

11. City

12. State

13. Zip

15. Volunteer Opportunities

    1. City Clean ups
    2. River Clean Up
    3. Internship
    4. Community Service
    5. Special Projects
    6. Office Work
    7. Emergency Response
    8. Surge Events
    9. Coaching

16. Name of Organization that you would like to sign up as a Community Partner.

    Please list the name of the organization and a contact person.

18. Related Skills or Work Experience

    Please list related skills or work experience

20. When are you available to volunteer

    1. Weekend AM
    2. Weekend PM
    3. Monday AM
    4. Monday PM

    1. Tuesday AM
    2. Tuesday PM
    3. Wednesday AM
    4. Wednesday PM

    1. Thursday AM
    2. Thursday PM
    3. Friday AM
    4. Friday PM
22. Are your volunteer hours required for a class or school?

    1. Yes
    2. No

23. Are your volunteer hours required to fulfill court-ordered community service?

    1. Yes
    2. No

25. Please take a moment and let us know what do you enjoy about volunteering or why is volunteering in Petersburg important to you?

27. Emergency Contact - Please list Name, relationship, physical address and phone number.

29. I understand upon approval I will be required to sign a Waiver Form prior to my volunteer service

    1. Yes
    2. No

30. Signature

    This serves at your signature which certifies the above information.

31. Email Address

    Please provide your email address

33. Date

    Month/Date/Year

34. Office Use Only

Leave This Blank:


36. 1. Receive email copy
37. Email address

    This field is not part of the form submission.

38. Submit Submit and Print

* indicates a required field