VOLUNTEER INTAKE FORM

VOLUNTEER INTAKE FORM
Habitat for Humanity Gibson County, TN
Disclaimer: Thank you for your interest in volunteering for Gibson County Habitat for Humanity . This form is used to collect information about new volunteers and used for internal purposes only. The information you provide is confidential and will be treated accordingly.
Name
Street Address
City
State
Zip Code
EMail
example@example.com
Phone
Date of Birth

MonthDayYear
Date
Spoken Language(s): English Other:
Other
Current Volunteer Work
Do you need to fulfill a specific requirement of volunteer hours?
Student
Other
If yes how many hours are you required to fulfill
What is the deadline
List and physical or medical limitations:
Emergency Contact Name
Relationship
EMail
example@example.com
Phone
List the days and times you are available to volunteer
Would you like to be notified about one-time, short-term volunteer opportunities? Yes
Kind of volunteer assignment desired
Skills and qualifications
Highest level of education: Driver's License? Yes No
Highest level of education
I recognize that the opportunity to participate in the program may involve physical labor and may carry a risk of personal injury and I hereby agree to assume all risks which may be associated with my participation.
I hereby release discharge waive and relinquish all claims liabilities and damages I may sustain from bodily injury personal injury or property damage and hold harmless the its officers directors employees and agents
Volunteer Signature

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Date

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Date
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