Volunteer Form

First Name (required)

Last Name (required)

Middle Name

Title
MrMrsMissMaster

Nick Name

Street (required)

City (required)

State (required)

Zip Code (required)

Cell Phone (required)Ok to call me

Email (required)

Demographic Information

Please provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Date of Birth (required)

Age (required)

Gender (required)
MaleFemale

Education (required)
Associate DegreeCollege DegreeDoctoral DegreeHigh SchoolMasters DegreeSome CollegeTrade/Vocational School

Country (required)
MonroeOtherOwen

Student
Retired

Availability
Please indicate the days and times you are usually available to volunteer.

MondayMorningAfternoonEvening
TuesdayMorningAfternoonEvening
WednesdayMorningAfternoonEvening
ThursdayMorningAfternoonEvening
FridayMorningAfternoonEvening
SaturdayMorningAfternoonEvening
SundayMorningAfternoonEvening

I will like to serve up to : (required)
Hours
BiweeklyDailyMonthlyOne TimeWeekly (required)

Clinic Hours/Shifts: Sunday 12pm - 3pm and Wednesday, 5pm - 8pm. What Shift are you available to volunteer?

Agreement Section
I certify that all the statements herein on this volunteer information sheet are true and correct and have been given voluntarily. I understand that this information may be shared with any legal and proper interest, and I release the agency from any liability whatsoever for supplying such information. I understand I will not be paid for my services in my volunteer capacity. I agree to abide by the Place of Hope Inc policies and procedures.

I also allow the Place of Hope Inc to use my picture(s) and/or comments for newsletters, public relations mailings and for any other Place of Hope related, legitimate purpose."

I Agree