Three Little Birds Perinatal & Palliative Care Advocacy & Support Center
City, State and Zip
During which hours are you available for volunteer assignments? (may check more than one)
I am currently
High School Student
Employer or School Name
Occupation or Major
In what areas specifically are you interested in volunteering?
Angel Gown Collection/Storage
Etsy Item Production or Development
Grant Writing, proof reading
Fundraisers (Hosting or coordinating)
General Office Support
Becoming a Doula
Community or Healthcare Outreach
How did you find out about volunteering for TLB?
Special Skills or Professional Qualifications
Please list any special skills or qualifications you have that would be an asset when volunteering for our organization.
Name and Phone Number of Person to Notify in Case of An Emergency
Please list 2 people who do NOT live with you that would be willing to serve as personal references for you.
1) Name, relationship to you, phone number
2) Name, relationship to you, phone number
By agreeing below, I affirm that all the facts set forth in this application are true and complete, and have been given voluntarily. I have answered all of the questions to the best of my ability and I have not and will not withhold any information that would unfavorably affect my application to be a volunteer. I will update Three Little Birds if any information on this application changes or of other information that might affect my qualifications as a volunteer. I understand any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate rejection as an applicant to be a volunteer or my termination as a volunteer.I voluntarily give Three Little Birds the right to make an inquiry of my past experience and I agree to cooperate in such inquiries and release from all liability or responsibility all persons, companies, and corporations supplying such information.In addition, I agree that I will keep confidential all materials that I may read or learn about during my volunteer experience. I will only discuss this information with appropriate staff and never off Heart-to-Heart grounds. If I ever use any part of my experience in writing, I agree that a member of the staff must review it first in order to protect the confidentiality and legal rights Three Little Birds families it serves.
Please Print Name Below: (for use as signature)
Send me a copy of my responses.
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