Please provide the following information:
First Name Last Name Street Address Address (cont.) City State Zip Code Work Phone Home Phone FAX E-mail Employer Name I prefer to be contacted: Work phone Home phone Email
First Name
Last Name
Street Address
Address (cont.)
City
State
Zip Code
Work Phone
Home Phone
FAX
E-mail
Employer Name
I prefer to be contacted:
Work phone Home phone Email
I understand that background checks are required for any volunteer having direct access with children.
Yes No
How did you find out about Heart House?
Friend Word of Mouth Heart House website Volunteer Match website Other website Community or neighborhood organization Other
What special skills, areas of expertise, interests, training, or other hobbies do you bring to this volunteer opportunity? Is there anything you can tell us in order to best match you to the volunteer role you would be most happy in?
Although not necessary, we would like to hear about any previous volunteer work that you have done, especially any experience working with children and youth:
How many hours are you able to volunteer per week?
Please indicate your preferences(check as many as apply):
Monday Tuesday Wednesday Thursday Friday Afterschool Tutors (What's this?) Afterschool Support Volunteers Program Prep Volunteers Friday for Fun volunteers Email me about other upcoming fall opportunities I would like to make a special presentation to the children Call me when you need volunteers for field trip or special occasions
Flexible volunteering or non-direct care:
Special events committee Donor development committee Marketing/public relations committee Office assistance Volunteer committee Whatever is needed most Volunteer on my own time (off-site, committee work, advocacy)
