Volunteer Information

Volunteer Application - Individual

* Required Fields

Contact Information

First Name

Last Name

Address

Address 2

City

State/Province

Zip/Postal Code

Cell Phone

Work Phone

Home Phone

Add me to your contact list

Are you over the age of 18?

Volunteer Information

Why do you want to volunteer?

Are you interested in a particular Service Line?

Days and time available

How did you hear about us?

I understand that anyone working directly with clients must be over 18, pass a background check and be willing to complete a brief training

Yes, I understand

Do you have any physical needs
that require special arrangements?

If yes, please explain

Additional Details/Notes:

Skills, Experience & Credentials

Please list any skills, credentials or certifications

Privacy Policy
We take precautions to protect your information. We collect credit card or bank account information, names, addresses, and other data related to your transaction when you make a payment through our site. We use this information to process your payment.

Terms/Conditions
By submitting your payment, you authorize us to charge the account above for the amount specified in the Transaction Amount field. Account information for Recurring Pledges/Monthly Giving is encrypted and stored securely via SafeSave™ for automatic processing of your future payments. Notify us at anytime if you wish to discontinue your pledge.