Volunteer Information
How did you hear about us?  
Title *
First Name * M.I.
Last Name *
Address *
Address 2
City * State * Zip *
Home Phone (including area code) * Alternate Phone (including area code)
Cell Phone (including area code) Date of Birth (mm/dd/yyyy) *
Gender Ethnicity
Email Address *
Emergency Contacts
Name (First and Last) Name (First and Last)
Home Phone Home Phone
Cell Phone Cell Phone
Relationship Relationship
Volunteer Status *
Have you ever been a Red Cross volunteer?* If yes, where and when?
Employment Status *  
Do you have any physical or mental condition which might affect your ability to perform the type of volunteer services which interest you? * If yes, please explain any accomodations that might help:
Have you ever been reported to, or the subject of, an investigation or disciplinary proceeding before any local, state or federal agency? * If yes, explain:
Have you ever been convicted of a felony or misdemeanor? * If yes, explain:
Professional Licenses
Include Nurse, EMT and other professional license
Type and Number Expiration Date State
Volunteer Experience & Additional Skills
Have you ever held any Red Cross certifications?
If yes, please
Have any of your certifications ever been revoked?
Have you ever been a volunteer for another organization?
Additional Language skills (i.e. Spanish, French)

As a volunteer I would like to: * Choose up to three. For a description, click on the title below.

Blood Drive Volunteers
Disaster Services Human Resources
Services to Armed Forces
Disaster Mental Health Services
Disaster Health Services
Community Disaster Education Presenter
Client Services
Disaster Action Team
Disaster Services Communications Center
Pet First Aid Instructor
HIV/AIDs Instructor
CPR/First Aid/AED Instructor
Aquatics Instructor
Babysitter Training Instructor
International Services
Lifeline Installer
Lifeline In-Touch caller

First Choice
Second Choice

Third Choice
Volunteer Preferences
Service Area Preference * Please choose one Service Area at this time. Additional Service Area choices can be discussed during the personal interview.
Scott AFB Service Center / Bellville
Jefferson Co. Service Center / Arnold St. Charles Co. Service Center / St. Peters
Metro East Service Center/ Fairview Hts.
* Hours of Availability
Monday AM PM
Tuesday AM PM
Wednesday AM PM
Thursday AM PM
Friday AM PM
Saturday AM PM
Sunday AM PM
Volunteer Information Authorization *(please read thoroughly before submitting)
I understand that this is part one of an application process for a volunteer position. I understand that this is an application for a volunteer position and not a contract of employment. I further agree that as a Red Cross Volunteer, I may not accept payment for my services, and that I will incur the cost of uniforms and transportation. I understand that as a volunteer I am required to abide by all rules and regulations of the organization. I will also take required training where applicable. I further release all parties from liabilty for any damage that may result from furnishing information to you. As a condition of considering this registration, I will sign the neccessary documents and authorize the release of any information maintained by local, state or federal agencies. In addition, I authorize any verification of applicable licensure if it is required for my volunteer position. The statements made on this registration form are true, complete and correct. I understand that any misrepresentation, omission of information, or misleading and incomplete data shall result in possible disqualification from consideration or dismissal as a volunteer. The Red Cross retains the right of refusal of acceptance, and this application does not ensure that volunteer placement will be made.