Cancer Services Volunteer Application
Volunteers are vital to the success of our agency. In 2013, over 500 volunteers donated over 13,000 hours of service. We would love to have you as a volunteer too! Complete the application and the volunteer coordinator, Sue Kirby, will be in touch with you.
Personal Data
Name *
Address *
Enter street, city, state and zip code.
Primary Phone Number *
Secondary Phone Number
Email Address *
Date of Birth
Sex *
Race
Emergency Contact *
Enter name, relationship and phone number
Are you a cancer survivor? *
If so, what type of cancer and how long since diagnosis
Please list any other information you believe it would be helpful for us to know about you.
Volunteer Availability
When are you available to volunteer? *
Check all that apply
Required
Volunteer Opportunities
We try to match your skills, interests and abilities with the needs of our agency and the community. Please check any areas you have interest/skills in volunteering for. Contact the Volunteer Coordinator for additional information about each area of opportunity.
In Office Activities *
Check all that apply or None if not interested in office opportunities - - all activities to be performed between 9 to 5 Monday through Friday
Required
In Home Activities *
Check all that apply or None if not interested in in home opportunities
Required
Community Activities *
Check all that apply or None if not interested in community opportunities - usually done in evenings and weekends
Required
Do you want to be added to our mailing list? *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy