Volunteer Application

Print and mail to the address below.

Name_____________________________________________________________________________

Address___________________________________________________________________________

Telephone________________

Date of Birth___________

Any Physical Limitations?______________________________________________________________

Any Medical Limitations or Special Medications we need to know about?_________________________

___________________________________________________________________________________

IN THE EVENT OF EMERGENCY, CALL:

I prefer to work as:

Office Skills

Work & Volunteer Experience References:  Please list the names, addresses, and telephone numbers of three people who have knowledge of your skills and abilities who would recommend you as a volunteer.

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Special Interests, Hobbies, & Skills

____________________________________________________________________________________
____________________________________________________________________________________

How did you hear aboout Ronald McDonald House of the Four States?___________________________

Why do you want to be a volunteer for the Ronald McDonald House of the Four States?______________
____________________________________________________________________________________

Availability:

Please circle the DAY and TIME you wish to volunteer!

Are you available on major holidays? (New Year's Day, Easter, Memorial Day, Fourth of July, Labor Day, Thanksgiving, Christmas Eve, Christmas Day, Hanukkah)________

When Can you start?_________________________________________________

I certify that the information contained in this application is correct to the best of my knowledge.  I consent to my current employer and persons given as references responding to a verbal or written request of further information.

Please note:  No tobacco products of any kind are allowed anywhere inside the Ronald McDonald House of the Four States.

Please return this form to:

Ronald McDonald House of the Four States, Attn:  House Manager
3402 S. Jackson
Joplin, MO 64804

(417) 624-CARE (2273)
FAX:  (417) 624-0270

Do you have any suggestions or comments?____________________________________________
________________________________________________________________________________

FOR OFFICE USE ONLY:

Copyright © 1999 Ronald McDonald House of the Four States