Volunteer – Heal The World

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone*

Email*

Have you ever volunteered before?*

List previous experiences you have had working with children and/or youth:*

List gifts, training, education or other factors that have prepared you for children's/youth work:*

Have you ever been arrested or charged with any sexual offense, crime of violence or any offense relating to children?*

Have you ever been convicted of any sexual offense, crime of violence or any offense related to children?*

Is there anything from your past that would disqualify you from working with children in our organization?*

If you answered yes to any of the last 3 questions, you may explain in the space below.*

Electronic Signatures

By checking this box, I am agreeing to all parts of the Volunteer Statement.*

Date

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