Loudoun County Homepage PRCS Teen Volunteer Application
* indicate required fields

*The high expectations of the Teen Volunteer Program include the requirement that teens complete this application, contact references, and handle all professional communication themselves. By selecting “Yes” below, you certify that you are the teenager who is interested volunteering and not any other party.

*Please state your last name.

*Please state your first name.

*Please enter your middle initial.

*Please enter your date of birth in MM/DD/YYYY format

*Street Address

Apartment/Unit # if applicable

*City

*Email Address

*Preferred phone number in ###-###-#### format please.

*Have you been convicted of a felony or misdemeanor other than a minor traffic violation?

If yes, does the criminal conviction involve a barrier crime as defined by the Code of Virginia 63.2-1726? (If you are unsure, please view the list of barrier crimes at this url http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+63.2-1719 )

*Are you fulfilling court appointed community service hours?

If you need volunteer hours to fulfill court requirements, please contact Stuart Younkin at Stuart.Younkin@loudoun.gov to begin your service. The Teen Volunteer Program is not for court ordered community service.

*What attracted you to PRCS? What aspect of our work motivates you to seek to volunteer here?

*What have you enjoyed most about your previous volunteer work? About previous paid employment?

*Areas of Interest: (select all that apply)






*Ages of Interest: (select all that you are interested in working with)





*Availability: (select all that apply)





Emergency Contact Information. Please list 2 people who we can contact in the event of an emergency.

*Full name of 1st emergency contact

*Your relationship to 1st emergency contact

*Best phone number for emergency contact. (In ###-###-#### format please)

*Please list the city that your 1st emergency contact resides in.

*Full name of 2nd emergency contact.

*Your relationship to 2nd emergency contact.

*Best phone number for 2nd emergency contact. (In ###-###-#### format please)

*Please list the city that your 2nd emergency contact resides in.

If you have a medical condition that PRCS needs to be aware of, please describe.

*By selecting Yes, I certify that the statements made in this Volunteer Application are true, correct, and given voluntarily. I understand that the Loudoun County Department of Parks, Recreation and Community Services reserves the right to screen volunteers and the Department will not accept as a volunteer anyone who would jeopardize any aspect of service or safety of PRCS customers and staff. I understand that I will not be paid for my services as a volunteer, and I give my time freely to the department/division to which I am assigned. I will also not abuse any information, materials, or hardware I may use or obtain while volunteering.