Volunteer Application

Name(Required)
Date of Birth(Required)
Address(Required)
How do you prefer to be contacted?(Required)
Check all that apply

Back2Back Cincinnati

Have you been engaged in Back2Back's mission in the past?(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)

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)
Reference #2(Required)

Availability

What days are you available?(Required)
Check all that apply
What age group do you prefer to volunteer with?(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)
This field is for validation purposes and should be left unchanged.

Sponsor A Child or Family

Release of Information

Name of Participant(Required)

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)
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.
Provide the date of consent and submission of this form.
MM slash DD slash YYYY

Take A Mission Trip

Job Inquiry Form

Write A letter

Back2Back Intern Application