Reading Volunteer On-line Registration
		Reading takes place for 15-30 minutes weekly in Metro. Nashville Public Schools near downtown Nashville, Tennessee. Volunteers commit to read at the same school, day and time each week for at least two months. Love Helps, inc. provides the books, scheduling and one hour training session.
		To register as a reading volunteer, please complete the form below then submit.
By completing and submitting this form, you are stating your interest in becoming a reading volunteer. If you have any questions, please contact us. NOTE: all fields in Bold or marked with (*) must be filled in prior to submitting form.
Date:		*
		Title	First Name	Last Name		Suffix
Name:		Mr. Ms. Mrs. Dr. *	*	*
Email Address:		*
Required General Waiver and Release*
In participating in the LEADING by READING program, I hereby release and hold harmless Love Helps, inc., Metro. Nashville Public Schools and all sponsoring organizations from all claims of damages, demands, actions and causes of actions whatsoever, in any manner arising out of my participation in this program. I also give my full permission for use of my name and photograph in connection with this program.
	Yes, I consent to the Waiver and Release above.*
Home Address including Suite/Apt. No.
*
City: *				State: *	Zip: *
		area code		phone number
Hm Phone:
Cell Phone:
Employer: *
Work Address including Suite No.
City:				State:	Zip:
		area code		phone number
Wk Phone:
Wk Fax:
Current Occupation:
Current Title:
Previous Employer:
Previous Title:
Current Age:*			under 18 yrs.		46-65 yrs.
			18-25 yrs.		over 65 yrs.
			26-45 yrs.
Univ./College attended:
Degree(s) earned:
Do you have your own transportation?*					yes	no
Do you have any experience working with children?*					yes	no
	If yes, describe:
Are you a member of any civic/religious/professional organizations?*					yes	no
	If yes, list:
	Would any of these groups consider supporting Love Helps, inc.?				yes	no
					don't know
Do you use alcohol, tobacco or illegal drugs?*					yes	no
	If yes, explain:
Have you ever been accused of a crime or the subject of an injunction?*					yes	no
	If yes, explain:
IMPORTANT: please mark all of the days that you are available to read for 15-30 minutes between 11 AM - 1 PM.
You will only be assigned to ONE reading day. The exact time is set by the school's schedule.
	Monday			Thursday
	Tuesday			Friday
	Wednesday
Please mark which sessions for which you are available:
	October/November			March/April
	January/February
From which direction would you approach downtown Nashville?					unsure north south east west downtown
Comments:
You can also print this form out BEFORE submitting it to keep a copy for your records. BEFORE submitting, check that all fields with a (*) have been filled in
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