2019 Volunteer Registration Form

1

Are You A Christmas Miracles Recipient?* This field is required.

YESNO

2

Full Name* This field is required.

Prefix

First Name

Last Name

Suffix

3

Age, If Under 18

4

Are You A Student In Need Of Hours?

YESNO

5

What Name Would You Like To Go By On Your Name Badge?

6

Mailing Address* This field is required.

Street Address

Street Address Line 2

City

State

Zip Code

Country

7

Cell Phone* This field is required.

8

Home Phone* This field is required.

9

E-mail

10

Allergies/Medical Concerns We Should Be Aware Of:

11

In Cast Of Emergency Please Contact: (Name & Contact Number)

13

What Are You Volunteering For

Pre Christmas Miracles Toy Donation Collection Events

Toy Separation And Bagging According To Gender And Age

Christmas Miracles Holiday Party

16

Comments

17

Are You A Registered Sex Offender

YESNO

18

Due to conflict of interest we ask that you not volunteer if you have applied for assistance this year

19

Please verify that you are human* This field is required.