Volunteer Form

Date
MM slash DD slash YYYY
Name
First Last
Address
Street Address City State ZIP
Phone
Email
Reason for Volunteering
Number of Hours Desired
Which days of the week can you work?
Are you enrolled in school?
- Yes
- No
Grade in School
Do you have any physical limitations we should consider in a job assignment? If so, please explain.
Emergency Contact
Name
First Last
Relationship
Phone (if different from above)
Physician Information
Doctor Name and Phone
Hospital
Parental approval is required for volunteers who are under 18 years old. I give my approval for the person named at the top to be involved in Encore Thrift Store.
Parent/Guardian Signature
Date
MM slash DD slash YYYY

Emergency Contact