Volunteer Application

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Do you know anyone on Lila Mae's House team? (staff, board member, volunteer) *

Yes

No

Are you multilingual? *

Yes

No

Availability *

Check all that apply

Mornings

Afternoons

Evenings

Weekends

Holidays

Anytime

Do you have your own means of transportation? *

Yes

No

Do you have a valid Drivers License? *

Yes

No

Do you have any criminal convictions (other than parking violations or juvenile violations)? *

Yes

No

References *

Character Reference #1 (no relatives)

First Name

Last Name

Phone number *

(###)

###

####

Phone number *

(###)

###

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