Volunteer Application Form

First Name*:

Last Name*:

Street Address 1*:

Street Address 2:




Work Phone Number*:

Cell/Home Phone Number*:

May We Contact You At Work?  Yes No

Your Email*:

Congregation/Group Name (if applicable):

Please check the box or boxes of the area(s) in which you would like to volunteer*:
 Care Team Member In The Office (specify in Comments Section) Special Event (specify in Comments Section) One Day Wonder (specify in Comments Section) Other (specify in Special Skills Section)

Times and Days Available To Volunteer:

Any special skills that might help your volunteer experience (e.g. Carpentry, singer, musician, cook, languages, etc):

Please state in a few sentences your reasons for wanting to volunteer with The Care Communities

Write briefly about your experience dealing with people with serious illness such as HIV/AIDS or cancer: