1. Last Name: ____________________________ First Name:_________________________ Date:____________ *Name of Parent or Guardian if under 18 years: _____________________________________________________________________ * All applicants are required to go through a third party background check. If you are under the age of 18 a legal guardian needs to sign off on your behalf. the parent or guardian must also complete a volunteer application and agree to this process. Address: ______________________________, City: ________________, State: ___________, Zip Code: ______ Telephone Numbers: (H); ______________ (O): _____________ Cell: _______________ Fax: ______________ E-MAIL Address: _______________________________ Company or Volunteer Group Name: _____________________________________________________________ Date of Birth: __________________ Driver’s License No. ______________________ Do you drive [ ] Y [ ] N Emergency Contact: __________________________________________________________________________ (Name) (Tele. No.; Indicate Home, Work or Cell) (Relationship) ________________________________________ Do you have any friends/family members who are employed, chaperone or volunteer here? ______Yes ____ No When are you available to become employed, chaperone or volunteer (specify hours of availability)? Monday ___________ Tuesday __________ Wednesday _________ Thursday _________ Friday ________ Saturday___________ Sunday __________ Holidays only_______ [ ] Full time [ ] Part-time Type of employment, chaperone or volunteer work you think you’d be most comfortable with: _________________ Helping with a group activity: ______________________ Working one on one: __________________________ Foreign Languages : (please circle) Sign Language EnglishChineseDutch French German Greek Hebrew Hungarian Indonesian Italian Japanese Korean Norwegian Polish Portuguese Russian Spanish Swedish Turkish Ukrainian Vietnamese HONORING THE HEROES LEGACY THROUGH THEIR CHILDREN. Firefighter’s, EMS, Fire Rescue, Police Officer’s, First Responder’s and U.S. Military Personnel Volunteer / Chaperones / Employees Application and Agreement Form 1

2. List Your Past Volunteer and/or chaperone position and experiences : Organization: _________________________ Duties: ______________________ Mo/Yr. to Mo./Yr._________ Organization: _________________________ Duties: ______________________ Mo/Yr. to Mo./Yr._________ Have you ever been adjudged civilly or criminally liable for abuse of an individual with disabilities? No___ Yes___; Have you been convicted of a crime? No___ Yes___ If yes, please describe: Misdemeanor and/or Felony. __________________________________________________________________________________________ __________________________________________________________________________________________ BACKGROUND CHECK : American Eagle Children Dreamwish Foundation, Incorporated requires volunteers working with individual consumers known as children who have special needs or critically Ill Patients. The background check continues for all first responders and US Military children left behind. Prior to volunteering and/or employment status you will be required to go through a background check. We will look for any misdemeanors and/or any level 1., 2 or 3 Criminal convictions. This does not necessarily bar an applicant from volunteering being an employee or a chaperone. The nature of the offense will be taken into consideration before a decision is made for employment. There is no fee on the part of the volunteer, chaperone or employee for our background screening. Screening must be completed before volunteering, being a chaperone and/or an employee. I agree to have a background check. ___________________________ ______________________________ Print your full nameSignature as printed HEALTH : American Eagle Children Dreamwish Foundation, Incorporated requires that all employees with close consumer contact provide proof of a documented negative result on a Mantoux (Tuberculosis – TB) test completed within three years from the date of this application. _____ I agree to forward results from my most recent Mantoux (Tuberculosis – TB) test from my physician within two weeks of the date on this application. TEXT MESSAGING: If we have an urgent need, we may use text messaging to communicate this to you. If you're willing to receive text messages, please enter your phone number below. NOTE: Carrier messaging rates may apply. HONORING THE HEROES LEGACY THROUGH THEIR CHILDREN. Firefighter’s, EMS, Fire Rescue, Police Officer’s, First Responder’s and U.S. Military Personnel Volunteer / Chaperones / Employees Application and Agreement Form AMERICAN EAGLE CHILDREN DREAMWISH FOUNDATION, INCORPORATION 7823 North Dale Mabry Highway, Suite 102 1.844.DREAMWSIH Tampa, Florida 33614 1.813.252.6644 26/15/2016

3. Text message phone number: Cell Phone Carrier: Please indicate which carrier you use. HONORING THE HEROES LEGACY THROUGH THEIR CHILDREN. Firefighter’s, EMS, Fire Rescue, Police Officer’s, First Responder’s and U.S. Military Personnel Volunteer / Chaperones / Employees Application and Agreement Form AT & TVirgin Metro PCS T-MobileSprint Verizon REFERENCES: List three people, not related to you who have knowledge of your qualifications. Name:_______________________________________________________________________ Mailing Address:______________________________________________________________ City: _____________ State: __________ Zip Code: ________ Tele. No.:______________ Name:_______________________________________________________________________ Mailing Address:______________________________________________________________ City: _____________ State: __________ Zip Code: ________ Tele. No.:______________ Name:_______________________________________________________________________ Mailing Address:______________________________________________________________ City: _____________ State: __________ Zip Code: ________ Tele. No.:______________ AMERICAN EAGLE CHILDREN DREAMWISH FOUNDATION, INCORPORATION 7823 North Dale Mabry Highway, Suite 102 1.844.DREAMWSIH Tampa, Florida 33614 1.813.252.6644 36/15/2016

4. I need the following accommodation(s) to work as a volunteer, chaperone and/or employee:___________ As a volunteer, chaperone or a new employee for American Eagle Children Dreamwish Foundation, Incorporated, I agree to abide by all applicable rules and regulations of the organization. I understand that I will receive no monetary benefits in return for my volunteer service and that American Eagle Children Dreamwish Foundation, Incorporated, may terminate this agreement at any time without prior notice for any reason. I hereby authorize American Eagle Children Dreamwish Foundation, Incorporated, to check my references, and I understand that a criminal background check is required. I certify that my answers on this application are true and complete and that I have not knowingly withheld any information that might, if disclosed, affect my application unfavorably. I understand that any misrepresentation or omission of facts on this application could be cause for rejection of this application or dismissal. I understand that after I submit my application, it will be reviewed and my eligibility for volunteer work will be determined. I agree to an interview with the on site manager and on site orientation to perform my volunteer role. I hereby Release and Waive liability against American Eagle Children Dreamwish Foundation, Incorporated, a non-profit incorporation, its directors, officers, employees and agents, its successors and assigns, for any injuries or illness that I myself or my dependent may suffer in connection with any volunteer work for American Eagle Children Dreamwish Foundation, Incorporated. Further, I agree that American Eagle Children Dreamwish Foundation, Incorporated is not liable for any damage to my property or my dependent’s property resulting from volunteer work for American Eagle Children Dreamwish Foundation, Incorporated. The parent acknowledgers the fact they are aware of this background check. Volunteer Signature : _____________________________________________ Over the age of 18 Date :___________________________________________________________ Parent of a Volunteer _______________________ Date :_________________________________ Under age: Must be Parent or Guardian of child HONORING THE HEROES LEGACY THROUGH THEIR CHILDREN. Firefighter’s, EMS, Fire Rescue, Police Officer’s, First Responder’s and U.S. Military Personnel Volunteer / Chaperones / Employees Application and Agreement Form Office Notes: Back Ground Check ordered: [ ] Yes [ ] No Impression: _________________________________________________________________ ___________________________________________________________________________. Approved [ ] Yes [ ] No Signature of agent: _____________________ AMERICAN EAGLE CHILDREN DREAMWISH FOUNDATION, INCORPORATION 7823 North Dale Mabry Highway, Suite 102 1.844.DREAMWSIH Tampa, Florida 33614 1.813.252.6644 4