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: