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Events
Festival of Trees
9/11 Day of Remembrance
Sweetheart Dance
Donate
Home
About
Our Staff
Board of Directors
Contact
RSVP KC
RSVP-KC Volunteer Opportunities
Enroll as a Volunteer
Submit Volunteer Hours
RSVP KC Staff
FHVC P.A.C.T.
About P.A.C.T.
FHVC P.A.C.T. Task Force
FHVC P.A.C.T. Ambassador Program
P.A.C.T. Presentation Request
Programs
Volunteer Opportunities
Connecting Students to Communities
Neighbor 2 Neighbor
Medical Transportation
Volunteer
Request Volunteers
Become a Volunteer
Volunteer Enrollment
Student Volunteer Enrollment (Under 18 only)
Group Volunteer Enrollment
Submit Volunteer Hours
Submit Volunteer Hours for Individuals
Submit Group Volunteer Hours
Events
Festival of Trees
9/11 Day of Remembrance
Sweetheart Dance
Donate
Medical Transportation Volunteer Application
Step
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Volunteer Information
Name
*
First
Middle Initial
Last
Address
*
Please list local address if it differs from your permanent address.
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Type of Phone:
*
Home, Mobile, Work
Email
*
Driver's License #
*
Driver's License State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Birth Date
*
MM slash DD slash YYYY
Automobile Insurance
All volunteer drivers must meet at least the minimum auto insurance coverage requirements by the state of Kansas as stated in K.S.A. 40-3104. The Flint Hills Volunteer Center may ask volunteers to provide a copy of current auto insurance card at any time.
Insurance Carrier
*
Policy #
*
Agent or Agency
Driving Record
Have you been charged with any traffic violation(s) within the last three years?
*
Yes
No
If yes, please explain:
Vehicle Information
Please provide information about the vehicle being used for volunteer driving service
Year
*
Make
*
Model
*
License Plate#
*
Color
*
Availability
Please indicate all the times you may be available to serve as a volunteer driver. (For example, if you are available any Tuesday and the 1st Wednesday or the mornings on Fridays, please indicate on the appropriate days.)
Monday
Tuesday
Wednesday
Thursday
Friday
Please indicate any places you are NOT available to travel to.
Medical Information
Do you have any medical or physical conditions that may interfere with your ability as a volunteer driver?
*
Yes
No
If yes, is the condition corrected with medications or other means? If so, please explain:
Emergency Contact Information
Emergency Contact
*
First
Last
Relationship (spouse, child, etc.)
*
Phone
*
Volunteer Signature
If any information provided on my application shall change, I shall inform the Flint Hills Volunteer Center in a timely fashion.
*
First
Middle
Last
Date
*
MM slash DD slash YYYY
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.
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