Volunteer

Name*

Address

City/State/Zip

Phone*

Cell Phone

Email*

Date of Birth*

Do you speak a 2nd language?

Yes
No

What language(s)?

Church Affiliation

Being affiliated with a church is NOT a requirement of volunteers at PCM

Address

Phone

Pastor

Have you been convicted of or pleaded no contest to a felony within the last five years?*

Yes
No

If yes, please explain briefly

Hobbies and skills

What interests you the most about volunteering at PCM?

Do you have any special needs or disabilities to be aware of?*

Days available*

Monday
Tuesday
Wednesday
Thursday
Friday

Hours Available*

9 am-12 pm
1 pm-3:30 pm

Would you be willing to commit for at least 6 months?*

Yes
No

Comments

Emergency Contact

Name*

First Last

Phone*

Address*

City/State/Zip

Reference #1

Name*

First Last

Address*

City/State/Zip

Phone*

Email

Reference #2

Name*

First Last

Address*

City/State/Zip

Phone*

Email

I certify that, information contained in this application is true and complete. I understand that false information may be grounds for not considering me as a volunteer. I authorize the verification of any or all information listed above.

Type your full name*

Date*

Emergency Contact

Reference #1

Reference #2

ADDRESS

HOURS