Make a Difference With CHiP

Make a Difference With CHiP

Your time, compassion, and willingness to serve can bring hope to someone in need.
Full Name (First & Last)*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Mailing Address (optional)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MondayTuesdayWednesdayThursdayFridaySaturdaySunday
MorningsAfternoonsEvenings
WeeklyTwice per monthMonthlyOccasionally/As needed
Office/Admin SupportGuest Welcome / Front DeskFood Distribution / Meal ServiceCleaning / OrganizingEvents & OutreachMentoring / SupportTransportation AssistanceWherever Needed Most
Skills & Experience
Please list any helpful skills, experience, or certifications (optional).
Background Information
YesNo
YesNo
NoYesPlease describe your limitations.
YesNo
If yes, please explain
Optional
Emergency Contact Information
Emergency Contact
Phone Number
Relationship
Why do you want to volunteer with CHiP? (Please be specific about how you would like to help)*
“I confirm the information provided is accurate and I agree to follow CHiP’s Volunteer Expectations and Code of Conduct.”
Volunteer Agreement & Acknowledgment
My service with CHiP is voluntary and unpaid I will follow CHiP leadership and policies I will treat all individuals with dignity and respect I will maintain confidentiality I understand there are risks and release CHiP from liability I agree to respect CHiP’s Christian mission and values
I agree to the above terms
Typed Full Name (Signature)*
Type your full legal name
Date*

MonthDayYear
Date
Parent/Guardian Name and Phone Number if under 18
Optional
Should be Empty:

Make a Difference With CHiP

Background Information

Emergency Contact Information

Volunteer Agreement & Acknowledgment