Application for Volunteer Service

Tell us about yourself: (* denotes required fields)
Date
First Name * MI		Last Name *
Address		City
State       Zip		Email *
Home Phone *		D.O.B (mm/dd/yyyy)
Work Phone *
Cell Phone *
Previous Employer: Current Employer: Person to notify in an emergency: Phone: Education level reached: How did you hear about Read to Grow? Media Friend Have you had any prior volunteer experience? Yes No If yes, please explain: Volunteer Jobs: Please indicate all the areas in which you are interested in volunteering: (Select all that apply.) Office / Computer Work Prepare Mailings Data Entry Assemble program materials     Books for Kids Count & sort donated books Prepare book allocations Pick up and deliver books     Books for Babies Visit with families (trained through Hospital Volunteer Services) Assemble baby packets Read to children in pediatric waiting rooms     Special Events Assisting with special events Staffing special events Are you willing to be called in on short notice? Yes No Please check the day(s) you are available: (Select all that apply.) Sunday Monday Tuesday Wednesday Thursday Friday Saturday Personal History: Do you have any physical or psychological condition or handicaps that may affect your ability to perform certain volunteer assignments? Yes No   If yes, please explain: Do you have any lifting restrictions? Yes No   If yes, please explain: Have you ever been convicted of a crime? Yes No
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