Volunteer Application : Volunteerism : Luther Home of Mercy

Contact Information

First Name (Required)

Last Name (Required)

Date of Birth

Volunteers must be 8 or older to volunteer.

Month

Day

Year

Address (Line 1)

Address (Line 2)

City

State

Zip Code

Phone (Required)

E-mail Address (Required)

Emergency Contact Name (Required)

Emergency Contact Phone (Required)

Emergency Contact Relationship to You (Required)

If you're under 18, please list your parent/guardian as your emergency contact.

Additional Details

Hobbies, Talents or Special Interests (Required)

Group/School (if applicable)

Why do you want to volunteer?

Have you ever been convicted of a crime?

If yes, please describe.

If you have been convicted of a crime, please describe.

I give consent to Luther Home of Mercy to use: Photographs, Video/Audio Recordings of me and Creative Expressions (art, music, writing, quotes, etc.) of mine in their publications, social media and other promotional materials.

Your Signature (Enter your full name) (Required)

By typing my name below, I certify that the facts in this application are true and accurate to the best of my knowledge. I release Luther Home of Mercy from liability in case of any accident that occurs while participating in their activities and programs. I also understand it is my responsibility to notify the Mission Advancement Department of any changes in information which I have provided on this application. I understand I must work with & under the supervision of LHM staff at all times. I also understand LHM is not obligated to provide volunteer hours, nor am I obligated to accept hours.

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Date (Required)

Parent/Guardian Signature (Enter your full name)

If you're under 18, please have a parent/guardian/group leader also sign.

Parent/Guardian Email

Date