402-362-0127 info@lwrmyork.org

Volunteers Form

Name *
Address *
City *
State *
Zip *
Phone *
email *
Date of Birth
Age
Spouse
Occupation
Church
Training
 
Whom we would contact in case of an emergency
Name
Phone
Name
Phone
 
Do you belong to any civic, fraternal, or secretive organizations?
YesNo If Yes, Name of Organization 
 
References
Relative
Phone
Friend
Phone
Pastor
Phone
Jail ministry, preaching, and teaching requires your pastor's recommendation.
 
BarberElectricianPantryBible StudyHousekeepingPhotographyCarpenterJail MinistryPlumbingComputersKitchenPrayer PartnerData EntryMaintenanceTeachingDonationsNurseYard WorkDrivingPainting
Other
 
What motivated you to volunteer at the mission?
 
Other comments you would like to make: