Please provide the following information:

First Name

Last Name

Street Address

Address (cont.)

City

State

Zip Code

Work Phone

Home Phone

FAX

E-mail

Employer Name

I prefer to be contacted:

Work phone
Home phone
Email

I understand that background checks are required for any volunteer having direct access with children. 

Yes
No

How did you find out about Heart House?

What special skills, areas of expertise, interests, training, or other hobbies do you bring to this volunteer opportunity?  Is there anything you can tell us in order to best match you to the volunteer role you would be most happy in?

Although not necessary, we would like to hear about any previous volunteer work that you have done, especially any experience working with children and youth:

How many hours can you commit to volunteering per week?

Volunteer Preferences

Direct care with children (check as many as apply):

Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Afterschool Tutors during homework time 
Afterschool Support Volunteers during activity time 
 Program Prep Volunteers 
Friday for Fun volunteers
Email me about other upcoming fall opportunities
I would like to make a special presentation to the children
Call me when you need volunteers for field trip or special occasions

If I decide to volunteer with the Heart House children, I agree to commit to volunteer at least 1 and 1/2 hours a week for three months.

I understand

Flexible volunteering or non-direct care:

Special events committee
Donor development committee
Marketing/public relations committee
Office assistance 
Volunteer committee 
Whatever is needed most 
Volunteer on my own time (off-site, committee work, advocacy)

For demographic reporting to funders, please check the button that best describes you:

High school student
 College student/graduate student
 Professional
 Senior/retired
 Parent/guardian/family member
 Other