Application

Please feel free to fill out the application below to join our group. Or, to complete an application at your leisure, click here. Print the form, fill it out and fax to us at (941) 792-3680. Or, feel free to Contact Us for additional information. (All of the information provided is kept strictly confidential and is not shared outside our organization in any way).

Red Cross Youth Corps Manatee... Youth Shaping America.

Personal Information
First Name:
Last Name:
E-mail:
Street Address:
City:
State:
Zip:
Home Phone:
Grade Level:
School Attended:
Parent or Guardian Info
Parent/Guardian Full Name:
Day Phone:
Evening Phone:
Emergency Contact Info
Emergency Contact Name:
Relationship:
Address:
City/State/Zip:
Phone:
Additional Information (The following information is used ONLY to determine the diversity of Red Cross volunteers. Completion is optional, however it is helpful to us in developing a complete record of our program)
How did you hear about us?
Sex:		Male Female
Date of Birth:
Ethnic group:
Are you disabled?		Yes No
I understand that I must abide by the rules and regulations of the American Red Cross, and agree I will perform my services to the best of my abilities.