Kindly Fill this form To Volunteer 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 DegreeBachelor’s DegreeDoctoral DegreeHigh SchoolMasters DegreeSome CollegeTrade/Vocational School Country (required) USAOther 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