TODAY’S DATE:Name:Date of birth: Home Phone: Cell Phone:Current address:City: State: ZIP Code:Email:Employer’s Name/School’s Name:Education/Special Training:Occupation/Academic Major:Language(s) Spoken:

Placement Preferences: Please indicate 1st, 2nd, and 3rd choice.______ 1. Special Events Volunteer______ 2. Peace For Kids Child Development Center Volunteer ______ 3. Family Program Volunteer______ 4. Our Lady of Perpetual Help Volunteer______ 5. St. Philippine Home Volunteer______ 6. Maintenance/Grounds Volunteer______ 7. Clothing/Donation Closet Volunteer______ 8. Administrative Volunteer______ 9. Other: ___________________________________________________________________________

Why would you like to volunteer at Queen of Peace Center?__________________________________________________________________________________________________________________________What would you like to get out of your volunteer experience at Queen of Peace Center?__________________________________________________________________________________________________________________________Volunteer Type and Availability:

One Time: _____ Regular (20+ hours): _____ Seasonal or Events Only: _____ On-call:_____

Other: _________________________ to __________________________

Available Start Date: ______________________________ Proposed End Date: ________________________

Preferred Day(s) of the Week to Volunteer: ______________________________________________________

Preferred Timeframe(s) to Volunteer: ___________________________________________________________

EMERGENCY CONTACT: In the event of an emergency, please list the person you would want notified.

Name: _________________________________________Phone Number: _____________________________

Street Address: ___________________________________ City: ______________________State: _________

Email Address: ______________________________________ Relationship: ___________________________

Statement of Understanding:

I certify that all information is true and has been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest. I release the agency from any liability whatsoever for supplying such information.

I understand that people of all ages are welcome to volunteer at Queen of Peace Center, but if under the age of 18, is required to have parental consent. I understand that anyone under the age of 14 is required to bring their own adult supervision.

Upon being offered a volunteer position, I understand that I may be required to provide additional information pertinent to the position for which applied.

SIGNATURESSignature of applicant or legal guardian: Date:Printed name of applicant or legal guardian: Date: