Betty's Book Buddies Volunteer Application

Volunteer Application
Thank you for your time in completing the form below and for your interest in A Child’s Haven!!

Should you have any questions, please direct them to:

Rebekah Muhilly, Volunteer Coordinator
A Child’s Haven
20 Martin Drive
Greenville, SC 29617
(864) 298-0025 Ext. 2012 Fax (864) 298-0045
Email: rebekahm@achildshaven.org
Your Name

First NameLast Name
Birth Date

MonthDayYear
Date
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
Work Address

Street Address

Street Address Line 2

CityState

Zip Code
Your preferred address for A Child’s Haven to contact you.
Preferred Email Address
Preferred Phone Number

Area CodePhone Number
Organization/Affiliation (if applicable):
Organization Phone Number

Area CodePhone Number
EMERGENCY CONTACT
Contact Name
Emergency ContactPhone Number

Area CodePhone Number
SKILLS AND INTERESTS
Education Background
Occupation
Hobbies
Skills
Interests
Previous Volunteer Experience
BACKGROUND VERIFICATION
Have you ever been convicted of a criminal offence?
Have you ever been charged with neglect, abuse or assault?
Have you ever been charged with neglect, abuse or assault?
Do you use illegal drugs?
Do you have any physical limitations or are you under any course of treatment which might limit your ability to perform certain types of work?
If Yes, please explain
REFERENCES

(Non-Family Members)
Reference 1
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Reference 2
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
PUBLIC AWARENESS
How did you hear about us?

Other
Would you like to receive volunteer opportunities periodically through your email address?
Should be Empty:

Volunteer Application

EMERGENCY CONTACT

SKILLS AND INTERESTS

BACKGROUND VERIFICATION

REFERENCES

PUBLIC AWARENESS