EmailMe Form - Volunteer with CBM

Home church *

Home church city *

Home church state *

Adult 1 *

First Last

Email *

Birthday

MM / YY

Adult 2

First Last

Email

Birthday

MM / YY

Child 1

First Last

Age

Birthday

MM / YY

Child 2

First Last

Age

Birthday

MM / YY

Child 3

First Last

Age

Birthday

MM / YY

Child 4

First Last

Age

Birthday

MM / YY

Child 5

First Last

Age

Birthday

MM / YY

Cell phone *

### - ### - ####

Home phone

### - ### - ####

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Preferred form of contact *

Birthday

Special Skills
What ways they would like to volunteer
(e.g., construction, electric, landscaping, cooking, cleaning, painting, etc.) *

Areas of Interest *

Any physical limitations *

yes

no

I can provide proof of medical insurance or equivalent

yes

no

If yes, please explain

Dietary restrictions or allergies *

yes

no

If yes, please explain

Notes/questions

Date of arrival *

MM / DD / YYYY

Time of arrival

Please note that check-in time is any time AFTER 4:00pm EST on the Sunday the Work Week begins. *

HH : MM AM/PM

Date of departure *

MM / DD / YYYY

Time of departure

Please note that check-out time is any time BEFORE 10:00 am EST on the Friday the Work Week ends. *

HH : MM AM/PM

Referred by (if applicable)