Application and Waiver

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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 *

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 (Full Name, Relationship, Phone Number) *

Availability *

Tuesday 12pm - 4pm (Junior High & High School Refugee Program)

Wednesday 3pm - 6pm (Wednesday Elementary Program)

Thursday 12pm - 4pm (Junior High & High School Refugee Program)

Tuesday & Thursday 10am-11:30am (Teaching English to Immigrant Youth 16+)

2nd Saturday of Each Month 9am - 1pm (Super Saturday, Mobile Pantry)

Periodic Saturdays Throughout the Year 9am - 1pm (Block Parties)

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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