Neighborhood Longhorns Program

To volunteer, please complete the following questionnaire.

Volunteer Details

First Name

Last Name

Phone

Email Address

Local Address

City

State Zip

Home Address

City

State Zip

Phone

Emergency
Contact

Emergency
Contact Phone

Classification

Major

Organizational Affiliation

Have you volunteered with Neighborhood Longhorns before?

Yes
No

If "Yes" when and where did you volunteer?

When are you available?

Monday

Tuesday

Wednesday

Thursday

At what time are you available?

Do you have transportation?

Yes
No

Are you bilingual?

Yes
No

If "Yes," what language?

Would you like to work with an ESL (English as a Second Language) student?

Yes
No

Mentor Preference?

Girl
Boy

Assumption of Risk/Release of Liability It is understood that The University of Texas at Austin does not provide medical insurance covering injuries of any nature incurred during participation in the Neighborhood Program. The undersigned hereby release The University of Texas at Austin, its successors, assignees, offices, agents, and employees from any and all claims, demands and causes of action whatsoever in any way growing out of or resulting from the participation in the Neighborhood Longhorns Program. All participants should be covered by their own insurance policies.

I agree