Volunteer Information Form

Submission of this information is voluntary, and refusal to provide it will not subject you to any adverse treatment. This information will be kept confidential. When reported for writing grants, etc. data will not identify any specific individual and will only be summarized when reported

Date of Birth:
Languages spoken other than English (select all that apply):
Optional - If you are a member of a faith based organization, please share here:
If employed, does your employer provide grants or matching funds for volunteer hours?
If you were referred by a current volunteer or staff member please name them here:
Volunteer Start Date
Primary Emergency Contact Information:
Secondary Contact Information:

As a volunteer I agree that my services are donated to Matthews HELP Center without compensation or future employment. I agree to grant permission without compensation to Matthews HELP Center to use my name, voice, statements, photographs, and other reproductions and likenesses for promotional purposes (e.g. press releases, audio visual and printed materials). I agree to comply with the policies and procedures set forth by Matthews HELP Center.

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