Registration Form - Volunteer Program

Corcovado Foundation

*Name :

*Date of birth

*Age:

*handed:

*Adress:

*Telephone numbers:

*Fax:

*E-mail:

*Country:

*Passport Number (include photocopy):

*Insurance Company:

*Insurance Number Policy(include photocopy):

*Insurance Expiration Date :

Contacts in case of emergency: #1

Name:

Rrelationship to the volunteer:

Telephone numbers:

Fax:

E-mail:

Contacts in case of emergency #2

Name:

Rrelationship to the volunteer:

Telephone numbers:

Fax:

E-mail:

*How did you hear about us?

*In which dates are you available for volunteering?

Education

*Formal

*Other

*Work Experience:

(Describe your responsibilities, dates and places of work. Include any other information that you consider important)

*Experience as a Volunteer

(Describe your responsibilities, dates and places of work.)

Languages

Areas of Interest

*Which activities would you be interested in as a volunteer?

(name) fully agree to participate in the Volunteer Program of the Corcovado Foundation. I have read and I understand all the information about the Program. I release Corcovado Foundation and any other governmental, non- governmental organization or private company involved in the activities of the Program of any and all legal, financial, labor or moral responsibility in case of any accident, incident and/or inconvenience, including, but not limited to, personal injury, death, loss or damage to personal possessions. I declare that I agree to make no claim, legal, financial, labor, moral or otherwise on any of the aforementioned organizations and companies.