Volunteer Application

(812) 437-7233

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VOLUNTEER APPLICATION FORM

* Indicates required field

Name *

First

Last

Phone Number *

Work Phone Number *

Address *

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City

State

Zip Code

Country

Email *

Employer or School *

Job Title *

Emergency Contact

Name *

First

Last

Phone Number *

Address *

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Line 2

City

State

Zip Code

Country

Availability

Available Days *

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Please check all that apply.

Length of Commitment *

On-going One time

Areas of Interest *

Special events Fundraising Community awareness Office assistance Outdoor landscaping assistance

Please check all that apply.

What hours are you available? *

Are you able to complete a background check? *

Yes No

How did you hear about Holly's House? *

Previous and Current Experiences in Volunteering

Name of agency, supervisor, and duties *

Organizations you are currently involved with *

Photograph Release

Required *

I give Holly’s House my permission to use images and/or video taken of me to be included in marketing including but not limited to: publicity, illustration, advertising, web content, and social media. I understand that no royalty, fee, or other compensation shall become payable by reason of such use. I do not give Holly’s House my permission to use my image for any use.

Affirmations

I certify that all information submitted by me on this application is true and complete. I understand that if any false information, omissions or misinterpretations are discovered, my application may be rejected and active volunteer status may be terminated at any time. In consideration of my volunteer application, I agree to adhere to the policies and regulations of Holly's House, Inc.

Name *

First

Last

Date *

Submit

Holly's House, Inc. | P.O. Box 4125, Evansville, IN 47724
Phone: 812-437-7233 | Fax: 812-437-7241

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Holly's House, Inc. | P.O. Box 4125, Evansville, IN 47724
Phone: 812-437-7233 | Fax: 812-437-7241