Lifecycles Louisiana Volunteer Application

Additional Information for Your Volunteer Position(s)

1 X Volunteer

Date of Birth:*

Occupation:

Employer:

Previous volunteer experience if any (none required to participate):

Do you have children in the program?*

Special Certification (i.e. CPR, Medical, et.):

Do you have a valid driver’s license?*

In which of the following would you like to participate? (Check one or more)*

Leader/Mentor

Ride with us

Food Prep/Serv

Setup/Take Down

Other

Have you ever been convicted of or plead guilty to any crime(s):

Have you ever been refused participate in any youth programs?*

Have you ever received deferred adjudication for an offense or otherwise required to register as a Sex Offender under any state or federal statute?

If you answered “Yes” to question 1, 2 or 3, provide complete details:

Read and Sign Waiver

I certify that all statements on this Application are true and correct. As condition of volunteering, I give
permission for Lifecycles Louisiana to conduct a background check on me, which may include a review of sex
offender registries, child abuse and criminal history records. I understand that, if approved, my position is
conditional upon the ministry receiving no inappropriate information on my background. I hereby release and
agree to hold harmless from liability Lifecycles Louisiana, their officers, employees and volunteers thereof, or
any other person or organization that may provide such information. I also understand that, regardless of
previous appointments, Lifecycles Louisiana is not obligated to appoint me to a volunteer position. If appointed,
I understand that I am subject to suspension by the Director and removal by the Board of Director for violation
of Lifecycles policies or principles.

I certify that all statements on this Application are true and correct.

Your birthdate

IP: 18.97.14.87
Jan. 25, 2025

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