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Youth Volunteer Application & Parental Consent Form

All Crossroads Community Services volunteers who have not reached the age of 18 must submit this Volunteer Application and Parental Consent Form from their parent or guardian prior to volunteering.

In addition to the consent form, those under the age of 14 must be accompanied by a parent, guardian or adult chaperone.

Phone Number
ext Extension
Availability and Volunteer Interest
Time of Year
I am available on the following days and times:
Areas of Interest

By submitting this form, the legal guardian of the above listed individual, is confirming that he/she understands the following:

  • Crossroads Community Services makes every attempt to select Staff and Volunteers that work effectively with young people, and who have no history of child abuse or other child victimization;
  • Crossroads conducts its programs so that individual adults are never left alone for any extended period of time and/or isolated with an individual young person, unless the individual is the young person's parent or guardian;
  • Crossroads makes every attempt to provide an environment where young people may perform their volunteer service with ample security and safety, including presence of an off-duty Dallas Police Officer whenever client-entry doors are unlocked to the public;
  • Crossroads makes every attempt to provide policies and procedures designed to create a personal shield of safety around each young volunteer;
  • While Crossroads makes every effort to provide a safe and secure atmosphere, it is possible that clients coming to the agency may behave in a way that is not congruent with Crossroads policies and procedures;
  • In signing this form I am confirming my consent for my child/children to volunteer at Crossroads despite these possible risks;
  • I understand that my child/children is/are not covered by insurance policies held by Crossroads Community Services;
  • I hereby release Crossroads, their leaders, and all other associates of Crossroads of any liability for injury or death.
In case of an emergency, I can be reached at this phone number during the time when my child/children is/are volunteering:
Phone Number
ext Extension
Alternate Emergency Contact
Phone Number
ext Extension
Legal Guardian's Signature (type your name twice to sign)

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