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Home
About
Our Staff
Board of Directors
Contact
Kansas City RSVP
KC Staff
Enroll as a Volunteer
Submit Volunteer Hours
FHVC P.A.C.T.
About P.A.C.T.
FHVC P.A.C.T. Task Force
P.A.C.T. Training 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
Volunteer Enrollment
Volunteer Enrollment Form
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12
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Why are you interested in volunteering?
*
I am looking for long-term opportunities where I can help on a regular basis.
I am looking for short-term, occasional ways to help my community.
I need service hours for school, fraternity, sorority, etc.
I need court-ordered service hours.
How many hours do you need?
*
By when do you need to complete your hours?
*
Please explain why you need court-ordered service hours.
*
Your ability to volunteer through our office depends on why you were charged/ convicted.
What age group are you in?
*
Please select one.
18 - 54
55 and up
In what county do you reside?
*
College students- please select where you live while attending college.
Riley
Geary
Pottawatomie
Wyandotte
Johnson
Jackson, MO
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
*
Preferred Contact Method
*
Phone
Email
No preference
Birth Date
*
MM slash DD slash YYYY
Age
*
Are you a Veteran of the Armed Forces?
*
Yes
No
Are you a family member of a Veteran?
*
Yes
No
Are you currently in the Armed Forces?
*
Yes
No
Are you a student?
High School
College
Not a student
If yes, what is your anticipated graduation date?
Statistical/Demographic Information
What is your gender identity?
Male
Female
Non-binary/ third gender
Prefer not to say
Racial Identity:
Caucasian/ White
African American/ Black
Hispanic/ Latino
Asian
Hawaiian/ Pacific Islander
Native American/ Alaskan Native
Prefer Not to Say
Other
Ethnic Group:
Hispanic/ Latino
NOT Hispanic/ Latino
Prefer not to say
Do you identify as LGBTQ+?
Yes
No
Prefer Not to Say
Do you have access to reliable transportation?
Yes
No
Are you a person with a disability?
*
Yes
No
Prefer not to say
If so, please let us know how we can accommodate or support your performance as a volunteer.
Have you ever been convicted of a crime other than a minor traffic citation?
*
Such as ANY felony and/or misdemeanor crimes including assault, battery, domestic battery, theft, shoplifting, DUI/DWI, possession, criminal damage to property, trespassing, vandalism, etc. If you need court-ordered service, please select "yes".
Yes
No
Please provide details such as location, date, and type.
*
A conviction may prohibit or limit you from volunteering.
Volunteer Experience & Interest
Please list 3 skills, hobbies, or areas of interest for volunteering:
Do you speak a second language? If so, please specify:
Please share any specific volunteer projects you are interested in.
Media Release & Promotional Materials
Media Release and Promotional Materials
*
I give permission for the Flint Hills Volunteer Center to publish the photographs taken of me and my name for use in FHVC's printed publication and website. I acknowledge that since my participation in publications and websites produced by FHVC is voluntary, I will not receive financial compensation. I further agree that my participation in any publication and website produced by FHVC confers upon me no rights of ownership whatsoever. I release FHVC, it's contractors, and it's employees from liability for any claims by me or a third party in connection with my participation.
I DO authorize the use of my name and picture for this purpose.
I DO NOT authorize the use of my name and picture for this purpose.
Referred by:
How did you hear about the Flint Hills Volunteer Center?
Current Volunteer, Community Agency, Staff, Internet, etc.
Transportation and Insurance Statement
Would you like to be covered by our excess insurance coverage?
*
RSP Volunteers (aged 55 and older) can opt in to be covered under our FREE Excess Volunteer Liability, Excess Accidental Medical, Excess Automobile Liability Insurance, and Accidental Death Coverage. This insurance is secondary to your primary insurance. If you choose to opt in, additional information is requested.
Opt IN to coverage
Opt OUT of coverage
RSVP Excess auto liability insurance asks for the following:
Driver's License State
Driver's License #
Expiration Date
Beneficiary Name
First
Middle Initial
Last
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
Relationship
Phone
Emergency Contact
*
First
Last
Relationship (spouse, child, etc.)
*
Phone
*
Confidentiality Statement
I acknowledge that I will abide by all the confidentiality guidelines set forth in the Flint Hills Volunteer Center Volunteer Handbook. I WILL NOT: Discuss a volunteer or client in front of that person or any other individuals, volunteers, or clients; Discuss a volunteer or client in front of other volunteers, visitors, or staff not directly involved with that volunteer or client.
*
I agree
I do not agree
Acknowledgement of Enrollment
By enrolling as a volunteer with the Flint Hills Volunteer Center, I acknowledge:
*
Please check each box to indicate agreement.
Select All
I volunteer my services through the FHVC and understand that I am not an employee of the RSVP grant, the sponsor, the volunteer station of the Federal government, and agree to serve without compensation.
I understand that if I use my personal automobile in my volunteer service, I agree to keep in effect automobile liability insurance equal to the minimum limits required by the state in which I reside.
I hereby give my consent for the Flint Hills Volunteer Center and, if necessary, the volunteer position, to conduct any necessary background checks.
I understand that the information provided on this form may be disclosed for the purpose of volunteerism only.
I commit to maintain the confidentiality of all proprietary or privileged information to which I am exposed while service as a volunteer, whether this information involves staff, volunteer, member, or other person involved in overall agency business. I understand that violation of confidentiality will result in immediate dismissal from my volunteer assignment.
Volunteer Signature
By typing your name and dating, you are verifying that all information provided is accurate and truthful.
*
First
Last
Today's Date
*
MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.
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