Name:

Address:

Phone: Email:

Are you a student? YES NO

Education / Special Training:

PLEASE CHECK DAY(S) YOU ARE AVAILABLE TO VOLUNTEER:

SUN MON TUES WED THU FRI SAT

PLEASE CHECK TIME OF DAY YOU ARE AVAILABLE:

MORNING AFTERNOON EVENING ANYTIME

Do you have any health / physical limitations?

Please list two references (non-family members eg: Employers, Teachers, Volunteer Supervisors, Co-Workers etc):

Name: Phone:

Name: Phone:

AREAS OF INTEREST FOR VOLUNTEERING (check all that apply):

customer service - retail store

merchandising / display - retail store

training assistant - workforce development

client assistant - successfully suited

antiques & collectibles assistant

data processing

delivery assistant - donation services

donations sorter - donation services

seamstress - successfully suited / retail

special events

other

IN CASE OF ERMERGENCY NOTIFY:

NAME:

ADDRESS: PHONE: