Your Name (required)

Phone Number

Your Email (required)

Occupation

Voca puts students in touch with people in fields of their interest. Would you be willing to have a 20 minute phone conversation with a student if asked?
 Yes No

Student Name

Student School

Student Grade

Student Phone Number

Student Email

We give students the opportunity to speak with adults who actually work in two fields of interest to the student. For us to set up these phone interviews, it is helpful for us to know in advance what fields of work are interesting to the student. Please consult with the student or ask them to list two roles they would like to explore. Be as specific or descriptive as possible. (Of course, we cannot guarantee we will be able to connect with such a person, but we will try)!
Role #1
Role #2

Favorite ice cream flavor

Name(s) of friend(s) possibly also attending

How did you hear about VOCA?
 friends school civic organization (chamber of commerce, etc).  church web/Facebook other

The volunteers in the VOCA program are giving their time and effort solely because they are passionate about making a difference in the lives of others. All volunteers have signed the Voca Volunteer Policy Statement. For our mutual protection, we need you to signify your permission to allow your student to participate in the program by clicking the box below.

I certify that I am the parent or legal guardian for my child(ren) who are participating in the Voca program. I hereby give my permission for any volunteer with Voca to seek and give appropriate medical attention for my child(ren) in the event of accident, injury, illness while participating in any Voca activities. I will be responsible for any and all costs associated with any necessary medical attention and/or treatment.

I hereby waive, release and forever discharge Voca and any volunteers from all rights and claims for damages, injury, loss to person or property which may be sustained or occur during participation in Voca activities, whether or not damages or loss is due to negligence. I hereby acknowledge that my children is (are) physically fit and capable of participation in all Voca activities.

By registering my child(ren) with Voca, I, as the parent or legal guardian, agree to allow my child(ren) to participate) in Voca, and hereby release Voca and its volunteers from liability for any injury that might occur to my child(ren) while participating in the Voca program, including travel to and from Voca sessions, meetings with Voca volunteers or other scheduled Voca activities.

I understand that Voca is staffed by adult volunteers who have each signed a Voca Volunteer Policy Statement, which is designed to provide assurance for the safety and protection in adult / minor relationships and establish clear boundaries of engagement between the minor child(ren) and the adult volunteers. I understand that my child(ren) may participate in interviewing with Voca volunteers for the sole purpose of vocation exploration and these interviews may be conducted over the phone or, if in person, in a supervised setting such as at the work location with other adults present. I understand that the Voca experience will include phone conversations with adult mentors about various vocations in which my child(ren) might be interested.

I agree to indemnify and hold harmless Voca and/or individuals, their agents and/or employees, against any and all liability for personal injury, or damage to the property to my child(ren), or both, while my child(ren) are participating in the Voca program.

I have read the above statement and indicate my agreement by checking the box.

Type what you see above: