Volunteer Profile & Medical Release
MHC is a nonprofit organization that provides community-based recreation programs for youth and adults with developmental disabilities with the aim to promote growth and development of participants, provide opportunities for personal enjoyment, and increase greater independence & involvement in the community
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Today's Date: *
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Name: *
Date of Birth:
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Address: *
Phone Number: *
Emergency Contact: *
Emergency Contact Phone Number: *
Medical Concerns: *
Allergies: *
Physician/Clinic:
Physician/Clinic Phone Number:
Required - Medical Release: *
Required - Criminal History Check *
Required
Required - Residency History *
Required
If you have had residency outside of Washington State within the last three years, please provide the state(s) and/or countries in which you have held residency. *
Optional: Photo Release
How did you hear about Max Higbee Center? *
Do you have any specific interests or skills? (i.e. crafting, administrative, fitness, etc.) *
Do you have prior experience working with people with developmental disabilities? *
Would you like to be included on our mailing list to receive our monthly newsletter? *
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