ILLINOIS VALLEY PADS Volunteer Information

All fields are required

Date

First Name Last Name
Age Sex Male Female
Address
City State Please Choose Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip
Phone (H) (W) (C)
E-Mail
Best Time to Contact Me

Provide Reference Name & Address


Are you performing Community Service Y N
How Many Hours?
For Reason Of


WHEN CAN YOU VOLUNTEER?

1st Shift (5pm-7pm) 2nd Shift (7pm-11pm) 3rd Shift (11pm- 3am)

4th Shift (3am-7am) 5th Shift (7am-9am)

Weekly Monthly Daytime Hours Other

Food Service ONLY (6:30 - 8:00 PM) Prepare and/or Serve Prepare Serve Prepare & Serve

Day of Week Sunday Monday Tuesday Wednesday Thursday Friday Saturday Any Day

Would you be able to come in on short notice to substitute in case of special need? Yes No


CHURCH GROUP NAME (if applicable)

Group Coordinator Name

Lily Pads Volunteers

Weekly Monthly 9am-1pm 1pm-5pm Other

Other information you may find helpful

Thank you for your support!