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: