HELP US.

The information you provide in this form makes it possible for us to coordinate your donations and volunteer time.

-Thank you!

First name

Last name

Phone

Email

Tell us about you and what you want to help with

What date will you arrive.

How many are in your group.

Will you sign a volunteer waiver.

Yes

No

Are you anyone in your group under the age of 18.

Yes

No

What do you want to help with.

Manual Labor

Supply Warehouse

Transporting Supplies

Mental/Spiritual Health

Health declaration

Date of birth

Have you or anyone in your group been hospitalized in the last 12 months.

No

Yes

Are you or anyone in your group suffering from a medical condition, illness or injury.

No

Yes

Do you or your group have any health concerns.

Yes

No

If you answered yes to any of the questions above, please supply additional information.

Signature

I declare that the info I’ve provided is accurate and complete.