Volunteer Information Form
Church/Group Affiliation: ________________________________________Dates Available: ________________
How did you hear about us? ___________________________________________________________________
Pastoral Reference: ______________________________________________ Phone: _____________________
Address: ________________________________________________________ Email: ____________________
Personal Information (Please have each member of your group complete and return this form to us.)
Name: ____________________________________________________________________________________
Address:___________________________________________________________________________________
City: ________________________________ State (Province): ______________________ Zip: _____________
Phone (Day): _______________________(Evening):_____________________ Email: _____________________
Place of Employment: _________________________________________________ Student: ____ Retired: ____
Special Skills: ______________________________________________________________________________
Single ____ Married ____ Ages of children coming with you: ________________________________________
Emergency Information
In an emergency, notify: ________________________________________Relationship: ___________________
Address: __________________________________________________________________________________
City: ____________________________________ State (Province): ___________________ Zip: ____________
Phone Number (Day): ________________________________ (Evening): _______________________________
Do you have any medical restrictions or handicaps that we need to make provision for? Yes ___ No ___
If Yes, please explain: ________________________________________________________________________
Are you currently taking any medication? Yes ___ No ___
If Yes, please explain: ________________________________________________________________________
Health Insurance Company: __________________________________ Policy Number: ____________________
Physician Information
Name: ___________________________________Phone Number (Day): ____________(Evening):___________
Address: __________________________________________________________________________________
City: __________________________________ State (Province): ___________________ Zip: ______________
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