An Affiliate of Love In The Name of Christ National

Temporary Volunteer Application

Name(Required)

First Last

Nickname

Date of Birth(Required)

Guardian's Name (if under 18)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Emergency Contact Relationship(Required)

If volunteering with a group, which group are you volunteering with?

Signature(Required)

Date(Required)

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Email

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