About me
Full Name:
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Driver's License Number
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Gender
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Male
Female
Birth Date:
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Month
/
Day
Year
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I am over 18. If you are a high school student please seek approval from your school for your hours served.
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Yes
No
Phone Number:
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E-mail Address:
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Home Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
My interests
My main areas of interest are:
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I can offer the following skills, knowledge and expertise:
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Which of these needs are you skilled in:
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Grant Writer
Fundraiser
Events
Other
What would make you feel that your volunteering experience has been a success?
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My emergency contact
Please provide the details of someone we can contact in the unlikely event of accident or illness while volunteering for Pennies for Haiti.
Emergency Contact's Name
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First Name
Last Name
Relationship
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Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
Emergency Contact E-mail Address
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Phone Number
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Format: (000) 000-0000.
Alt. Phone Number
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Format: (000) 000-0000.
Full Name:
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Relationship to you:
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Contact number:
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Thank you
for your interest in volunteering with Pennies for Haiti.
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