Volunteer Application - United Way of Adams County

Your Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Preferred method of contact: *

I am over the age of 18... *

Emergency Contact Information: (Name, Phone Number, Relationship to you)

Are you completing required or court-mandated Community Service hours? *

If yes, how many hours do you need?

Please explain the reason you need to complete community service hours

Please list any restrictions you may have... (Example: no heavy Lifting)

I'd like to volunteer for the following event(s) (check all that apply)... *

Please briefly describe the skills you'd like to offer

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