The Patricia M. Sitar Center for the Arts

Application for Community Service Work

(Information obtained will be kept confidential by the Sitar Center)

Name:                                                                                                     Date:                                                     

Current Address:                                                                                                                                                                

City:                                                                          State:                                     Zip:                                        

Home Phone:                                                                         Date of Birth:                                                       

Current School:                                                                                                                                                   

School Contact Person:                                                                    Phone Number:                                

Parent Contact:                                                                                      Phone Number:                                                

Email:                                                                                       

What are you volunteering to do? (e.g. help music students practice, teach music lessons, teach or assist in art/drama/writing/dance class)

How many hours of community service do you need, and what time commitment are you planning to make? (e.g. M & W 1-4pm from July-December 2002)

Date that you are available to start volunteering at the Sitar Center                                                                    

How did you first learn of the Sitar Center?

What are your expectations for your volunteer time here, and what do you hope to accomplish?

The Patricia M. Sitar Center for the Arts * 2525 Ontario Road, NW * Washington, DC 20009 * 202.797.2145

Have you had previous volunteer or youth work experience?                           Yes                         No          

If yes, please provide the name and phone number of your supervisor or person able to comment on your work:

References: Please print the name, address and phone numbers (work and home) of three people, other than relatives, who have known you for at least three years.

1.                                                                                                                                                                                            

2.                                                                                                                                                                                            

3.                                                                                                                                                                                            

I give permission for the Sitar Center and its authorized representatives to contact any of the above listed people for reference checks.

Signature of Applicant:                                                                                             Date:                                                      

Volunteer Consent

The Patricia M. Sitar Center for the Arts will take every reasonable precaution to provide for the safety of the volunteers while participating in the Sitar Center activities, which sometimes includes car or van travel. I understand that volunteers may not drive Sitar Center students unless such volunteers have valid insurance policies which contain the legal minimum for bodily injury, property damage and uninsured motorist.

By my signature, I acknowledge that neither the Sitar Center, nor any of its staff, nor participants will be held liable in the event of accident or injury to my person.

Signature of Applicant:                                                                                             Date:                                                      

Limitation of Contact with Students

I understand that the scope of my activites as a Sitar Center volunteer is limited to those activites authorized by the Sitar Center. I further understand that no volunteer may take any students on any outing not authorized by the Sitar Center. Please contact our staff if you have any questions.

Signature of Applicant:                                                                                             Date:                                                      

The Patricia M. Sitar Center for the Arts is a nonprofit, tax-exempt organization under IRS code section 501(c)3. The Federal Tax Identification number is 52-2113471.