Haitian Heritage & Friends of Haiti Volunteer Form
Thank you for your interest in being a volunteer for Haitian Heritage & Friends of Haiti (HHFoH). Please fill out the form below. If you have any questions, please contact Thomas Hall at thallems@yahoo.com or 704-574-0746.
Email address *
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Allergies *
Please list any known allergies. If none, put N/A.
Your answer
Prescription Medications *
Please any prescription medications that you are currently taking. If none, put N/A.
Your answer
Food Restrictions *
If none, put N/A.
Your answer
Emergency Contact Information
Name *
First & Last
Your answer
Relationship to Emergency Contact *
i.e. Mother, Father, Wife, etc.
Your answer
Phone Number *
Please include local area code
Your answer
Email Address *
Your answer
Insurance Information
Name Insurance Company
Your answer
Policy Number
Your answer
Phone Number of Insurance Company
Please include local area code
Your answer
Electronic Signature *
Please provide us with your full name below. I understand that checking this box constitutes a legal signature confirming that the information I have provided in this form is accurate.
Required
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