Volunteer Application

Name *

Title

First

Last

Suffix

Address *

Street Address
Address Line 2
City	State / Province / Region
Zip / Postal Code	Country

Phone *

(###)

###

####

Birthdate

/
MM

/
DD

YYYY

Are You Over Age 18? *

S.S.#

Emergency Contact:

Email

Emergency Contact / Phone

If Employed, Where?

How Did You Hear About Infant Crisis Services?

What Has Prompted Your Interest In Volunteering?

Special Skills:

(Please list any special skills, hobbies, or interests you may have that might be helpful in your volunteer work)

Do You Speak Spanish?

Volunteer Experience:

(Please list any previous volunteer experience)

References:

Please give two references, which are not related to you such as an employer, teacher, or friend.

Availability: Entire year ( January-December)
Summer Time ( May-August)
College / High School Short Term Project
Other

If Other:

Time Availability:

Number of hours per week:

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for may prohibit me from volunteering with Infant Crisis Services, Inc.

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Volunteer Application Form