A Room to Heal Volunteer Application
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Name
Address
City/Town
Zip Code
E-mail
Telephone
Employer (if applicable)
Emergency Contact
Contact Telephone
I would prefer:
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How did you learn about volunteer opportunities at A Room to Heal?  (check all that apply)
How would you like to be involved with A Room to Heal?  Check all that apply.
What skills (work experience, life experience, hobbies, education) are you interested in sharing?  Check all that apply.
Briefly describe your skills (ex., ADA renovations, etc.)
Please indicate any special interests or talents as well as any personal goals or concerns:
Have you ever been charged with a felony? *
If yes, please explain:
Due to the nature of our work, A Room to Heal reserves the right to conduct a background check on all individuals interested in volunteering. By initialing below, you acknowledge that this form has been answered truthfully, and you consent to a possiblle background check. *
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