Healthy Stores for a Healthy Community Volunteer Application
Date of Birth
In what city do you live in?
Phone Number (Mobile)
Alternative Phone Number
The Healthy Stores for a Healthy Community Campaign requires the use of a smartphone or tablet device to complete the survey. Please check which devices you own:
Please select the workshop that you will attend.
Saturday, May 14, 2016: 9AM - 1PM Location: One East Palo Alto
Friday, June 3, 2016: 12:30-4:30PM Location: Community Activities Building
Which organization are you affiliated with?
One East Palo Alto (OEPA)
North County Prevention Partnership (NCPP)
Peninsula Conflict Resolution Center (PCRC)
Redwood City 2020 (RWC 2020)
Youth Leadership Institute (YLI)
How did you find out about this volunteer opportunity?
San Mateo County website
What type of gift card are you interested in?
What are your reasons for wanting to participate as a "Healthy Stores for a Healthy Community" volunteer?
I am aware that if I am under 18 years old, it is required to have parent/guardian consent in order to participate as a volunteer. Not having a parent/gaurdian's signature will prevent me from participating in the program.
Thank you for filling out the Healthy Stores for a Healthy Community Volunteer Application. You will be contacted shortly through e-mail. If you have any questions, please call Grace Dadios at (650) 573-2026 or e-mail
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