Miramichi Boys and Girls Club Youth Leader Program Date Completed:  Type of volunteer help preferred ( check all that apply ): teaching an activity assist with group fundraising supervising an activity public relationship administrative helper maintenance cleaning driving special events helper Last Name:  First Name:  Mailing Address:  Community:  Postal Code:  Telephone (h):  Telephone (w):  Email:  Date of Birth:  Age:  Parents / Guardian Name:  Your Medicare #:  School:  Grade:   Work / Volunteer Experience:  Name 2 people we may contact as reference: 1)  Principal:  phone:   2) Other:    phone:  Please list some of your interests:  Do you have a driver's license? If yes, do you have use of a car?:  When are you available to volunteer? Please list day and time:  What prompted you to consider our   programs for volunteering?  Permission for photo release Completed By:  Date: