Full Name*

Preferred Name (e.g., Tom):

Address*

City*

State*

Zip*

Your Email Address*

Phone Number*

Date of Birth*

Emergency Contact Name*

Emergency Contact Relationship*

Emergency Contact Phone #*

Do you need Community Service hours?* Do you need Community Service hours?* Yes No

If yes, how many?

If yes, by when?

How often do you want to volunteer?* How often do you want to volunteer?* One time only Weekly Monthly Short-term project Substitute

Days Available* Days Available* Monday Tuesday mid-day Tuesday-evening Wednesday Thursday Friday

Months Available* (choose all that apply) Months Available* (choose all that apply) January February March April May June July August September October November December

What kinds of tasks would you like to help with?* (choose all that apply) What kinds of tasks would you like to help with?* (choose all that apply) Receive donations at the donation door Unload the food trucks Stock the food pantry Blessings in a Backpack Sort donations Assist in the Clothing Center Greet Neighbors and assist with light office tasks Meet with Neighbors to determine their needs Data entry or office administrative work Special projects (e.g., food drives, Saturday donation days)

Reference #1 Name (no relatives)*

Reference #1 Phone (no relatives)*

Reference #2 Name (no relatives)*

Reference #2 Phone (no relatives)*

Do you have any special skills that might be beneficial to BACN (e.g., event planning, fundraising, grant writing, marketing, communications, strategic planning, landscaping, construction, etc.)?

Background check Background check I hereby grant permission to Benzie Area Christian Neighbors to check with the appropriate authorities (police, courts, DMV) upon matters of record regarding background history. Any information will be strictly confidential.

Certify accurate information Certify accurate information By checking this box I certify that all information provided as part of this application is true and correct to the best of my knowledge. I give my consent to the sponsoring organization considering this application to use the information provided herein for the purpose of volunteer consideration.

Digital signature*

Date*

*Required fields