Individual Volunteer Application

Please complete the Individual Volunteer Application below and register for a tour and orientation using this link. Once we have received your application and registration, our Director of Volunteers will reach out to you for final confirmation.

Individual Volunteer Application

If you are human, leave this field blank.

Name *

First

Name *

Last

Email *

Primary Phone Number *

Secondary Phone Number

Address *

Apt. Number If Necessary

City *

State * AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Postal Code *

Date of Birth (MM/DD/YYYY) *

Church or Group Affiliation (if any)

Employer and Occupation

Would you like to receive occasional printed mailings from Christ House?

Yes

No

Note: Christ House will not sell, trade, or give your email or mailing address to anyone at any time.

Would you like to receive our monthly volunteer electronic newsletter?

Yes

No

Note: Christ House will not sell, trade, or give your email or mailing address to anyone at any time.

Volunteer Opportunities (Note: Please mark volunteer opportunities you are interested in.)

Meal preparation, serving, and clean-up

Phone relief receptionist during evenings, weekends, and/or holidays

Accompanying patients to and from medical appointments

OtherOther

Note: Please check the Individual Volunteer section of the website to see a brief description of the volunteer opportunities at Christ House.

Sunday Availability (Note: Please mark your availability.) *

7 to 9 am

11 am to 1 pm

5 to 8 pm

not available

Other: (please list)Other: (please list)

Monday Availability (Note: Please mark your availability.) *

7 to 9 am

11 am to 1 pm

5 to 8 pm

not available

Other: (please list)Other: (please list)

Tuesday Availability (Note: Please mark your availability.) *

7 to 9 am

11 am to 1 pm

5 to 8 pm

not available

Other: (please list)Other: (please list)

Wednesday Availability (Note: Please mark your availability.) *

7 to 9 am

11 am to 1 pm

5 to 8 pm

not available

Other: (please list)Other: (please list)

Thursday Availability (Note: Please mark your availability.) *

7 to 9 am

11 am to 1 pm

5 to 8 pm

not available

Other: (please list)Other: (please list)

Friday Availability (Note: Please mark your availability.) *

7 to 9 am

11 am to 1 pm

5 to 8 pm

not available

Other: (please list)Other: (please list)

Saturday Availability (Note: Please mark your availability.) *

7 to 9 am

11 am to 1 pm

5 to 8 pm

not available

Other: (please list)Other: (please list)

Do you need to fulfill a service requirement?

Yes

No

If yes: how many hours?

If yes: by what date?

How did you learn about Christ House?

Please share your reason(s) for wanting to volunteer at Christ House:

Please list a reference: (Name, Address, Phone Number and E-mail)

Volunteer Waiver and Release i. WAIVER AND RELEASE: I, the volunteer, release Christ House from and waive liability, claims, and demands of whatever kind, either in law or in equity, which arise from the services the volunteer provides to Christ House. I understand that this release discharges Christ House from any liability or claim that I may have against Christ House with respect to injury, illness, or property damage that may result from the services interns provide to Christ House, including from activities that may be hazardous to interns such as operation of kitchen appliances, use of kitchen instruments, use of cleaning products, travel, and exposure to various medical conditions. ii. PHOTOGRAPHIC RELEASE: I grant Christ House the rights to any photographs, images, video, or audio recordings that I may appear in while interning at Christ House.

By clicking below, you are acknowledging that you have read and agree to the Christ House Volunteer Waiver and Release above. *

I am aware of the requirements in maintaining confidentiality while volunteering at Christ House and I have read the waiver. I will keep all information observed and heard regarding Christ House patients confidential and I release Christ House from all liability while volunteering.