INFORMATION ABOUT YOU First name: * Last name: * Street address: * City: * State: * Indiana Illinois Zip code: * Email Address * Phone number (home or cell): * Phone number (work): Date of birth (mm/dd/yyyy) * Employer (if retired, former employer): Previous volunteer experiences EMERGENCY CONTACT INFORMATION First name: * Last name: * Relationship to you: * Phone number: * OTHER INFORMATION Days that you are available from 10:45am-12:00pm * Monday Tuesday Wednesday Thursday Friday Terre Haute Police Background Check. A back ground check will be run on all volunteers through the Terre Haute Police Department, at our expense. You will be asked to complete paperwork for this at a later time. Please type your name in the box indicating you understand this. * OUR POLICY: It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
