Facilitator Registration

Are you interested in being a part of a Next Chapter Book Club?

What is the Next Chapter Book Club? It's a unique community-based book club program for adolescents and adults with Down syndrome, autism, cerebral palsy and other intellectual and developmental disabilities. Our members (including some who cannot read) love books for the same reasons most people do. They enjoy being transported to different worlds where they meet interesting characters and learn about exciting new things. Taking that journey with a group of friends makes it even more delightful and fun.

Doesn't that sound like fun? We think so. In order to start a club, we will need lots of volunteers. Please complete our Next Chapter Book Club facilitator

Book Club Facilitator Intake Form

* Indicates required field

Name *

First

Last

Phone Number *

Address *

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City

State

Zip Code

Country

Email *

Occupation *

T-Shirt Size *

Do you have experience working with people with intellectual disabilities? If yes, please explain *

How did you hear about Next Chapter Book Club? *

What experience have you had with volunteer work? *

Do you have any concerns about facilitating a book club? *

When would you like to start facilitating a book club? *

What days and/or evenings and times are you available to facilitate? *

Have you ever been convicted of a misdemeanor or felony? If yes, please explain. NOTE: if you are convicted of any misdemeanor or felony while surving as a volunteer facilitator, you must notify NCBC staff within 30 days. Failure to do so may result in termination. *

Are you an insured driver? NOTE: Typically we ask that facilitators do NOT transport book club members; however, in case of emergency, only insured drivers should transport members. *

*Please read the following paragraph carefully, check the agree box and type your name below to agree to the following:
* I will protect the privacy of all member in by book club and keep all information shared by and about the members confidential.
* I am aware that I must undergo and pass a background check before facilitating a club
* I understand Next Chapter Book Club/ DSAA NE staff may take and use my photograph for the purpose of publicizing the program.
I certify that the information provided above is true to the best of my knowledge.

I have read or listened to the NCBC guidelines and will follow them to the best of my ability. *

I agree

By typing your name below, you are signifying that you agree to follow the above guidelines *

Date *

Submit

Are you interested in being a part of a Next Chapter Book Club?

Book Club Facilitator Intake Form

We Would Love to Hear from you!

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