Fields marked * are required.

Page 1 of 3

Contact Info

பெயர்

கடைசி பெயர்

Phone

Phone Type

Mobileமுகப்புப் பக்கம்Work

Address

Street Address

City

State

Postal Code

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Page 2 of 3

About You

Birthdate

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Employment Status

School

Are you volunteering for service learning hours and/or school credit?

Yes

How many service learning hours do you need to complete?

# of Years You Have Lived in California

Have you ever pled guilty or no contest, or have you ever been convicted of a crime involving theft, sexual misconduct or violence?

YesNo

Availability

Are you willing to make a 3-month commitment to Family House?

YesNo

Would you like to provide your daily availability?

YesNo

Monday Start Time

Monday End Time

Tuesday Start Time

Tuesday End Time

Wednesday Start Time

Wednesday End Time

Thursday Start Time

Thursday End Time

Friday Start Time

Friday End Time

Saturday Start Time

Saturday End Time

Sunday Start Time

Sunday End Time

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Page 3 of 3

Volunteer Information

How did you hear about Family House?

Why do you want to volunteer at Family House?

Do you have any previous volunteer experience? (If yes, please describe.)

What areas are you interested in?

Direct Assistance to Clients (baking, arts and crafts, therapy dogs, etc.)GardeningHouse Support (organizing, disinfecting)Office Support (data entry, event prep, fundraising support)Other

Other area(s) of interest

Emergency Contact

Emergency Contact Name

Emergency Contact Phone Number

Relationship to Emergency Contact

Special Accommodations

Do you require special accommodations in order to volunteer?

Please provide information/details on any special accommodations you will need in order to volunteer.

Anything else to add?

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