Volunteer Registration - Night to Shine Gallipolis 2020
Email address *
Volunteer Information
First Name *
Your answer
Last Name *
Your answer
Date Of Birth *
MM
/
DD
/
YYYY
Gender *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Parent Name (if under 18)
Your answer
Parent Phone
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Training & Skills Information
Former Special Needs Skills / Training (please check all that apply)
If you selected Healthcare Professional, please list your field or specialty:
Your answer
Do you have any other specialized training? (Please list and describe any specialized training)
Your answer
Night to Shine 2020 Information
I volunteered at Night to Shine Gallipolis in 2019: *
If you volunteered for the 2019 event, on what team did you serve on during Night to Shine Gallipolis 2019?
Your answer
Preferred Service Team for the Night to Shine Event: *
Secondary Service Team Option (Please select an alternate, you may need to be assigned to another team) *
Other volunteer opportunities:
There are other volunteer opportunities before our event. Please consider joining an event preparation team at a volunteer training meeting.

Clothing / Flowers / Prom Shop
Encouragement Cards
Gift Bags
Gym Decorating
Respite Room Decorating
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