BREATHE Volunteer Registration
Please complete the information below to register as a Breathe Volunteer.
First Name *
Your answer
Last Name *
Your answer
E-mail address *
Make sure this is one you check!
Your answer
Name of organization. *
Ex.: Church, High School, Service Club, etc.
Your answer
What size t-shirt do you prefer?
All t-shirts are adult sizes.
Grade for current School Year *
How did you learn about BREATHE? *
Your answer
Current Mailing Address *
Include street, city and zip
Your answer
Phone Number *
Your answer
Name of Emergency Contact *
Your answer
Phone Number of Emergency Contact *
Your answer
Diocesan Safe Environment Regulations for Adults *
In accordance with diocesan policy all adults (18 yrs and older) assisting with children must complete a background screening and attend the VIRTUS training.
In what capacity would you like to serve at BREATHE? *
Anything else you want to tell us?
Your answer
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