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(* denotes required fields)

School:

Name *:

Street Address *:

City *:

State *:

Zip *:

Phone:

(home)
(work)
(cell)

Email:

What is the best way to contact you?:

Phone
Email

Do you have any physical limitations?:

Do you speak Spanish?:

No
Yes

Previous work experience:

Previous volunteer experience:

Clubs, organizations or hobbies:

Tutoring children is a rewarding and challenging experience. Why do you want to volunteer as a tutor with Senior Buddy Readers?

The children with whom you volunteer need your commitment to the program in order to help them succeed. Senior Buddy Readers asks that you remain active in the program for the entire school year after you have been trained and are assigned students. Although we understand that sometimes emergencies arise, we ask that you make every effort to attend your regularly scheduled one-hour appointment and arrive on time. You must notify us as soon as possible if you will be out for your scheduled time. Will this be possible for you?

No
Yes

Emergency Contact Information

Name:

Street Address:

City:

State:

Zip:

Phone Numbers:

Relationship:

Please inform us of any special health concerns or medications that an E.M.T. would need to know about in case of an emergency.

After submitting this form, a staff member with Senior Buddy Readers will contact you.

Thank you for your interest!

* * * REQUIRED: