BA Jr. Volunteer Program Application

Please list the names and phone numbers of two personal references other than family members.

This information is of a confidential nature, and as such will not be shared with other personnel except for those involved in this specific volunteer position. All information collected will be kept confidential.

I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE THAT THE FOREGOING IS TRUE AND CORRECT. I authorize investigation of all statements herein and release Jays Party Shop from liability in connection with the same.

I certify and agree: By checking this box, I declare under penalty of perjury that all information provided is true and correct, and I authorize the investigation of all statements.

Date of Submission:

Parent/Guardian Name:

Phone:

Date:

Parent/Guardian Acknowledgment: As the parent/guardian of the applicant, I consent to their participation in the JBA Jr. Volunteer Program and agree to the terms above.

Name:
Address:
Phone:	Birthday:
E-mail Address:
Emergency Phone:	Emergency Contact Name:
Are you part of Educational Opportunity Center School? YesNo

1. Name:	Phone:	Relationship:
2. Name:	Phone:	Relationship:

Jays
Party
SHOP

JBA JR. VOLUNTEER PROGRAM APPLICATION

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Jays Party SHOP

JBA JR. VOLUNTEER PROGRAM APPLICATION

Made with by Cloud Media Pro

Cloudmedia

Jays
Party
SHOP