LIVESTRONG

Transportation Program Volunteer Application

Thank You!

Thank you for your application. A representative will contact you shortly.

Name
Address
Contact Information
Personal Information
Driver Information
Availability
Please indicate your volunteer day/time preferences and availability below.
Mon Tue Wed Thu Fri
Morning
Afternoon
Please indicate below how often you intend to provide volunteer transportation.*
Per Month Per Week

1 or 2 times per month

1 time per week

4 times per week

3 or 4 times per month

2 times per week

5 times per week

More than 5 times per month

3 times per week

As often as possible

Background
Vehicle
Emergency Contact
References: Please list two references we may contact who are not immediate family.
Reference 1
Reference 2

I authorize all information provided in this application to be released to Faith in Action Caregivers for the purpose of considering my participation as a volunteer driver in the LIVESTRONG Cancer Transportation Program. I confirm that all of the information I have provided is true and correct to the best of my knowledge. I give my consent for Faith in Action Caregivers and the Lance Armstrong Foundation to contact my references. I agree to indemnify and hold harmless the Lance Armstrong Foundation, Faith in Action Caregivers, or any other partner in this program from and against all losses, claims, damages, and liabilities to which any partner to the program may become subject arising out of or in connection with the LIVESTRONG Cancer Transportation Program. I understand that a criminal background check and a driving record check will be conducted. If volunteering to drive, I agree that I am responsible for maintaining a valid driver's license and current liability insurance on my vehicle and am obligated to notify Faith in Action Caregivers of change in status of either. I understand that giving false information or withholding information relevant to health conditions that would affect the ability to drive in a safe manner will be grounds for dismissal. All information is considered confidential by both the Lance Armstrong Foundation and Faith in Action Caregivers.