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Safe Harbor Volunteer Application
Personal Information
First Name
Middle Name
Last Name
Birth Date
MM
/
DD
/
YYYY
Preferred Title
Preferred Nickname
Street Address
Apartment Number
City
State
Zip Code
Home Phone Number
Please write only the number, No - 's or ()
Business Phone Number
Please write only the number, No - 's or ()
Other Phone Number
Please write only the number, No - 's or ()
I prefer to receive calls at
Required
E-Mail Address
Emergency Contact Name
Emergency Contact Phone Number
Please write only the number, No - 's or ()
Emergency Contact Relationship
Church Information and Reference
Church Name
Denomination
Pastor's or Church Leader's Name
Pastor Phone Number
Please write only the number, No - 's or ()
Volunteer Information
Please check all areas of interest
Safe Harbor Ministry Support
Required
If Guest Transportation what times are prefered
Send info on other opportunities
Required
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Resident of Michigan over 10 years
How did you learn about this volunteer opportunity?
When are you available (dates and times)?
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