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 *

Postal Code *

Date of Birth (M/D/YY)

Church or Group Affiliation (if any)

Employer and Occupation

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

Yes

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

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

Volunteer Opportunities (Note: Please check any volunteer opportunities you would be interested in.)

Meal preparation, serving, and clean-up

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

Accompanying patients to and from medical appointments

Leading/participating in patient events and activities

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