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Back2Back Cincinnati
Were you referred to Back2Back Cincinnati by a staff member? If so, please provide their name.
Have you been engaged in Back2Back's mission in the past?
(Required)
Yes
No
What church, if any, are you connected to?
Why would you like to volunteer with Back2Back Cincinnati?
(Required)
What are you expecting to get out of volunteering?
(Required)
If you volunteer, what would be your biggest concern?
(Required)
Please explain your past or present volunteer experience, if any.
(Required)
Are you a teacher, or do you have an education background? If yes, what grade level?
(Required)
Are you preparead to undergo screening and/or a background check, for our safety, yoru safety, and our clients' safety, at a cost to you?
(Required)
Yes
No
References
Please list 2 references that you have known for 2 or more years. Please include first and last name, phone number, email, and relationship
Reference #1
(Required)
First
Last
Reference #2
(Required)
First
Last
Relationship #1
(Required)
Relationship #2
(Required)
Phone #1
(Required)
Phone #2
(Required)
Email #1
(Required)
Email #2
(Required)
Availability
What days are you available?
(Required)
Check all that apply
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Select All
What age group do you prefer to volunteer with?
(Required)
1st-3rd grade
4th-6th grade
7th grade and up
Any
What times of day are you available?
(Required)
Can we add you to our mailing list to keep you up to date on site updates, community site events, and future volunteer opportunities? We will send quarterly emails and 1-2 communications through the mail.
(Required)
Yes
No
Phone
This field is for validation purposes and should be left unchanged.
Sponsor A Child or Family
Release of Information
Name of Participant
(Required)
First
Last
Release of Information (ROI) Consent
I understand my student’s story and/or my story is ours to share. I understand Back2Back Cincinnati will hold our information confidential unless necessary by law. I realize Back2Back Cincinnati can better serve my student and/or our family when they communicate to other individuals working with my student and/or our family. I give permission for Back2Back Cincinnati to give and receive information in regards to my student(s) and/or myself from Hamilton County Juvenile Detention Center (20/20), Hamilton County Juvenile Probation, Hamilton County Public Defender’s Office, Hamilton County Diversion Court Programs, Hamilton Prosecutor’s Office, and Hamilton County Juvenile Court.
Consent
(Required)
I CONSENT to the release of information.
Name of Consenting Guardian or Student (if over 18)
(Required)
Submitting your name below as a digital signature, you are acknowledging any release of information and understand that the permission can be revoked at any time by contacting Back2Back Cincinnati in written format either in email or letter.
First
Last
Date
(Required)
Provide the date of consent and submission of this form.
MM slash DD slash YYYY
Take A Mission Trip
Student Name
(Required)
First
Last
Additional Student Name
First
Last
Parent/Guardian Name
(Required)
First
Last
Field Trip Consent
Please provide consent or deny consent for the following planned field trip. A Yes or No response is required for every field trip. "Yes" indicates consent while "no" will result in a denial of consent and your student will not be able to participate in the activity.
Newport Levee | Monday 6/10/24 | 2:30-4:30
(Required)
One Levee Wy, Newport, KY 41017 | Pick Up at 2:30 pm, Drop Off at 4:45 pm
Yes
No
Mt. Echo | Monday 6/17/24 | 2:30-4:30
(Required)
251 Mt Echo Park Dr, Cincinnati, OH 45205 | Pick Up at 2:30 pm, Drop Off at 4:45 pm
Yes
No
Dunham Pool | Monday 6/24/24 | 10-2
(Required)
4356 Dunham Ln, Cincinnati, OH 45238 | Pick UP: 9:45 Drop OFF: 2:15 | Swimsuit Required
Yes
No
Kings Island | Monday 7/1/24 | 10-3
(Required)
6300 Kings Island Dr, Mason, OH 45040 | Pick UP: 9:45 Drop OFF: 3:15
Yes
No
French Park | Monday 7/8/24 | 2:30-4:30
(Required)
3012 Section Rd, Cincinnati, OH 45237 | Pick UP: 2:15 Drop OFF: 4:45
Yes
No
FC Cincinnati Game | Saturday 7/13/24 | 7:30-9:30
(Required)
1501 Central Pkwy, Cincinnati, OH 45214 | Pick UP: 7 Drop OFF: 10
Yes
No
Washington Park | Monday 7/15/24 | 2:30-4:30
(Required)
1230 Elm St, Cincinnati, OH 45202 | Pick UP: 2:15 Drop OFF: 4:45
Yes
No
Smale Riverfront Park | Monday 7/22/24 | 2:30-4:30
(Required)
166 W Mehring Way, Cincinnati, OH 45202 | Pick UP: 2:15 Drop OFF: 4:45
Yes
No
Mt. Echo | Monday 7/29/24 | 2:30-4:30
(Required)
251 Mt Echo Park Dr, Cincinnati, OH 45205 | Pick Up at 2:30 pm, Drop Off at 4:45 pm
Yes
No
Spruce Nails | Monday 8/5/24 | 2:30-4:30
(Required)
1818 Race St Suite 101, Cincinnati, OH 45202 | Pick UP: 2:15 Drop OFF: 4:45 | Your student will be getting their nails painted
Yes
No
Digital Signature of Consenting Guardian or Student (if over 18)
(Required)
By filling out your name as the parent, guardian, or consenting student (if over 18) below, you are signing in agreement with Back2Back's ability to take your child on extracurricular activities. This digital signature serves as an additional form of consent along with the choices above.
First
Last
Date of Submission
(Required)
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1920
Name
This field is for validation purposes and should be left unchanged.
Job Inquiry Form
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Back2Back Intern Application