| *Date: |
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| *Name : |
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| *Date of birth: |
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| *Age: |
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| *handed: |
Right
Left |
| *Adress: |
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| *Telephone numbers: |
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| *Fax: |
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| *E-mail: |
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| *Country: |
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| *Passport Number (include photocopy): |
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| *Insurance Company: |
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| *Insurance Number Policy (include photocopy): |
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| *Insurance Expiration Date : |
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Contacts in case of emergency: #1 |
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| Name: |
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| Relationship to the volunteer: |
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| Telephone numbers: |
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| Fax: |
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| E-mail: |
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Contacts in case of emergency #2 |
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| Name: |
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| Relationship to the volunteer: |
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| Telephone numbers: |
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| Fax: |
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| E-mail: |
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| *Hov did you hear about us? |
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| *In vhich dates are you available for volunteering? |
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Education |
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| *Formal |
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| *Other |
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*Work Experience: |
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| (Describe your responsibilities, dates and places of work. Include any other information that you consider important) |
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| |
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*Experience as a Volunteer |
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| (Describe your responsibilities, dates and places of work.) |
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| Languages |
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| Areas of Interest |
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| *Which activities would you be interested in as a volunteer? |
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| * I, (name) fully agree to participate in the Volunteer Program of the Corcovado Foundation. I have read and I understand all the information about the Program. I release Corcovado Foundation and any other governmental, non- governmental organization or private company involved in the activities of the Program of any and all legal, financial, labor or moral responsibility in case of any accident, incident and/or inconvenience, including, but not limited to, personal injury, death, loss or damage to personal possessions. I declare that I agree to make no claim, legal, financial, labor, moral or otherwise on any of the aforementioned organizations and companies. |
| *Signature: |
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| *Date: |
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| *ID# |
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| |
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