Volunteer Registration Form

Name*

First NameLast Name

E-mail*

Birth Date*

MonthDayYear

Cell Phone Number*

Area CodePhone Number

Home Phone Number

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Have you been accused, arrested, or convicted of any crime?*

YesNo

Have you been investigated by any state agency for misconduct?*

YesNo

Have you lost or been denied the privilege of carrying a concealed weapon?*

YesNo

Are you aware of physical, mental, or emotional issues that could affect your ability to serve within Graces of Gurley?*

YesNo

Are you aware of any reason you should not volunteer with Graces of Gurley?*

YesNo

If you answered yes to any of these, please explain in detail:

Name of Church

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Pastor's Name

First NameLast Name

Years attended:

1. Name*

First NameLast Name

Email

example@example.com

Phone Number*

Area CodePhone Number

2. Name*

First NameLast Name

Email

example@example.com

Phone Number*

Area CodePhone Number

3. Name

First NameLast Name

Email

example@example.com

Phone Number

Area CodePhone Number

Please indicate areas to volunteer in according to your skills

How did you hear about Graces of Gurley?

I recognize that Graces of Gurley, Inc. is relying on the accuracy of the information I provide on this application form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct.

I authorize the organization to contact any person or entity listed on the application form, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications.

I voluntarily release the organziation and any such person or entity listed on the application form from liability involving the communication of information relating to my background or qualifications. I have received and signed a notice to volunteers regarding background investigation and I authorize the organization to conduct a criminal background investigation.

I understand that Graces of Gurley is a faith-based organization, and therefore I will do nothing to contradict their religious beliefs while volunteering with the organization. Specifically, I will not engage in conversation, express opposing opinions, or share with our "neighbors" (clients/partners/volunteers) opposing views that contradict Graces' established set of beliefs. I agree to abide by and respect all the policies and procedures of the organization and to protect the health and safety of the people assigned to my care or supervision at all times.

Signature*

Volunteer Application

Your Information

Personal History

References