Volunteer Sign up Form

Volunteer Sign up Form

Thank you for your interest in getting involved with Easterseals! You will be contacted within one business week from when we receive your application.
PROFILE INFORMATION
Full Name*

First NameLast Name
Are you over 18?*

YesNo
Date of Birth*

MonthDayYear
Date
CONTACT INFORMATION
E-mail*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMERGENCY CONTACT
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
VOLUNTEER OPPORTUNITY
Which volunteer opportunities are you interested in?*

Event VolunteerCommunity Volunteer (Tabling & Advocacy in the community)Administration SupportHost your own fundraiser or eventOther
Have you volunteered with us before?*

YesNo
Where did you hear about us?
Is your Company/Organization Volunteering?*

YesNo
Company/Organization
How many members are in your Group?
ADDITIONAL INFORMATION (OPTIONAL)
Current Employer
Position/Title
Please list any special skills, trainings, or certifications
Why do you want to volunteer with Easterseals?
Additional Comments
**NOTE** Please be advised that Easterseals Midwest may have photographers, videographers, and media on hand at any event. Photographic images and video taken during any event are property of Easterseals Midwest and may be used for promotional purposes. By submitting your registration to attend an Easterseals' event, you irrevocably consent to allow Easterseals Midwest to use any photos and video containing your image and/or the images of those you have registered or brought to attend an event without impunity.
Should be Empty:

Volunteer Sign up Form

PROFILE INFORMATION

CONTACT INFORMATION

EMERGENCY CONTACT

VOLUNTEER OPPORTUNITY

ADDITIONAL INFORMATION (OPTIONAL)