Volunteer Application Form

Galilee Center Volunteer Registration Form
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Galilee Center has adopted a policy that establishes COVID-19 vaccination as a consideration for employment and volunteerism. Have you received your COVID-19 vaccine?

YesNo
What days would you like to volunteer?

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
When are you available to volunteer? Please select a time from the drop-down and then the hours you are available.
Time of day*
From

:HourMinutesAM/PM Option
To

:HourMinutesAM/PM Option
Previous Volunteer Experience
Special Skills or Qualifications

Skills and qualifications can be acquired through employment, previous volunteer work, or other activities such as hobbies or sports.
What skills or qualifications do you have as a volunteer?
Emergency Contact Information

Please provide contact information of a family member, spouse or relative in case of an emergency:
Emergency Contact Name

First NameLast Name
Relation
Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Email
example@example.com
Name of Physician
Physician Phone Number

Area CodePhone Number
Our Policy:

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Thank you for completing this application form and for your interest in volunteering with us.

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions or other misrepresentations made by me on this application may result in my immediate dismissal
Signature (please use your mouse to "draw" your signature)

Clear
Are you mandated to complete volunteer hours?

YesNo
How many hours are you mandated to work?
Should be Empty:

Galilee Center Volunteer Registration Form

Emergency Contact Information