Volunteer Interest Form

Volunteer Interest Form
Name:*

First NameLast Name
Address:*
City, State:*
Zip:*
Phone:*
Please enter a valid phone number.
Email:*
example@example.com
Date of Birth:*
ex: 02/19/1997
Emergency Contact Information
In case of emergency, contact:*

First NameLast Name
Relationship:*
Phone:*
Volunteer Area(s) of Interest:
Please check all that apply:

School Group Facilitators: Daytime hours (requires attending specialized training)Adult Group Facilitators: Evening hours (requires attending specialized training)Event Support: VMM Golf Outing (August)
Why are you interested in volunteering at COJ?*
How did you hear about COJ/what is your connection?*
By submitting my information, I affirm that the facts set forth are true and complete. I understand that if I am accepted as volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my withdrawal for Companions on a Journey Grief Support Inc.
Signature:*

Clear
Today's Date:*

MonthDayYear
Date
Should be Empty:

Emergency Contact Information