VOLUNTEER REGISTRATION FORM
Last Name:___________________________ First Name____________________________
Phone:________________________ E-mail:________________________________________
Emergency Contact: Name__________________________________ Phone____________
VA Volunteer? Y N Organizational Affiliation:_______________________________
VA Employee? Y N Location: ____________________________________________
Hours worked beyond the normal workday or on holidays will be considered strictly volunteer hours
and I understand that I will not be paid overtime, compensatory time, holiday pay, premium pay or
differential pay. I certify that the information on this application form is accurate and true to the best
of my knowledge. I hereby waive all claims to monetary benefits for services rendered as a
volunteer worker on a “without compensation basis.” I understand this waiver applies only to
compensation for specific services rendered in the Voluntary Service Program and has no relation
to any compensation for other services to which I may be entitled.
Signature_______________________________________________ Date_________________
___________________________________ , minor child, has my approval and support to work as
a volunteer at VA St. Louis Health Care Welcome Home Celebration.
Parent/guardian signature __________________________________Date_______________
Please check what event(s) you are interested in:
Please return application to: Voluntary Service (135/JB) 1 Jefferson Barracks Dr., St. Louis, MO 63125
FAX: 314-894-5705 or E-Mail: maura.campbell2@va.gov
Event Date Timeframe
Stand Down Friday, November 9
th
Morning
Stand Down Friday, November 9
th
Afternoon
Welcome Home Saturday, November 10
th
Morning
Welcome Home Saturday, November 10
th
Afternoon
Veteran’s Concert
Afternoon
2018 WELCOME HOME CELEBRATION
Homeless Veteran Stand Down and Veteran's Concert
Friday-Sunday, Nov. 9-11, 2018
Sunday, November 11th
Click to Submit Electronically