Volunteer Application (Fields marked with an asterisk* are required)

Have you ever been convicted of a felony?*

Are you interested in becoming a Driver for Meals on Wheels? (If you choose not to become a Driver, skip ahead to the line that says, "I will not be a driver for Meals on Wheels")*

Have you ever had your license suspended, revoked or refused?

In the past 10 years have you been convicted of driving while intoxicated or under the influence of drugs?

Are you a veteran?*

Volunteer Positions: Please check off your interest(s)*:

I agree to release Claremont Meals on Wheels ("MOW") from all liability relating to injuries that may occur during my volunteer activities. I acknowledge the risks involved in volunteer activities, in which I am participating voluntarily. I also fully understand that MOW does not assume responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance, in the event of injury illness, death or property damage. I will also make every effort to obey safety precautions as listed in writing and explained to me verbally. I hereby release and forever discharge and hold harmless MOW and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either law or in equity, which arise or may hereafter arise from my volunteer activities with MOW. *PHOTO RELEASE: I hereby grant and assign MOW all rights, title and interest in all photographic images and video or audio recordings that are made during my work with MOW.*

(Applicants - DO NOT FILL OUT THE FOLLOWING SECTION, IT IS FOR INTERVIEWERS ONLY)

Approved:

Day:

Week:

Driver's License Verified: