Application and Waiver

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*Please use a personal EMAIL address and not one linked to your university/school.

Email *

Under 18 Requires Parent/Guardian's Consent *

By checking this box, I understand that if I’m under 18, my parent or guardian needs to fill out this form for me.

Required

First and Last Name *

Your Gender *

Male

Female

Phone Number (Include Area Code) *

Birthdate (*Several of our programs have a minimum age requirement of 13 years old.) *

YYYY

Address (Street Number, Name and Apt#) *

City, State, Zip *

How did you hear about Kim's Open Door? *

Emergency Contact... Their Full Name, Relationship, Phone Number *

Availability *

Mondays 2:30pm - 5:00pm ('Monday Meetups' Elementary Program)

Tuesdays 1pm - 4pm (Junior High & High School Refugee Tutoring & ESOL Program)

Wednesdays 3pm - 6pm (Wednesday Elementary Program)

Thursdays 1pm - 4pm (Junior High & High School Refugee Tutoring & ESOL Program)

JaxTHRIVE (High school volunteers only – for those serving with JaxTHRIVE on select Saturdays)

Offsite Mobile Pantry, 2nd Saturday of Each Month 9am - 1pm

Required

Summarize special skills and qualifications you have acquired from employment or previous volunteer work, including performing arts, hobbies, or sports.
*

Kim's Open Door sponsors faith based and non-faith based programs. What is your religious affiliation and why?
*

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