* please fill in all required fields

Title Mr Mrs Ms

*First name:
*Last name:

*telephone:      
work telephone:
cell telephone:  
email:              

*address:
*city:      
*state:    
*zip:       

TELL US A LITTLE MORE ABOUT YOU

1. Do you have a community service requirement that you need to fulfill?
Yes No

If yes, number of hours:   
To be completed by (date):
Hours are required for: School Court Religious or Service Group Other:

2. How did you hear about Grenville Baker Boys & Girls Club?:
My child attends the Club Alumni Newspaper TV Internet/Website Work School Mail Friend Other

SKILLS & INTERESTS

3. What specific interests, skills or areas of expertise would you like to bring to GBBGC?

4. Please identify the group (age group, gender) or program that you are interested in working. If no preference, please comment as such.

 5. List any foreign languages written or spoken.

 6. Describe any past volunteering experience.

  AVAILABILITY

This section will help determine the best days and times you would like to volunteer. Please mark all days and times you would be available. Club is open Monday – Thursday 3:00 p.m. to 9:00 p.m. Friday 3:00 p.m. to 11:00 p.m. and Saturday 9:00 p.m. – 4:00 p.m.

7. Day(s) available:
Monday Tuesday Wednesday Thursday Friday Saturday
Sunday

Hours available:
Morning Afternoon Evening Specific Hours:

8. Are you affiliated with a business, school, group or organization that might be interested in becoming involved with Grenville Baker Boys & Girls Club?
No Yes – If yes, how are you connected?

  Affiliation Name:

address:
city:      
state:    
zip:       

telephone:  
email:        


Please complete application and fax to (516) 671-4681 or

email Christine at christine.thomaides@gbbgc.org.