First Name

Last Name

Email

Phone

Address

City

State

Zip

Will you be volunteering with a company, school, church or organization?

• Yes
• No

If so, what is the name of the organization and the department or group with it?

Name of contact person (if different than above)

Contact's phone number

Will you be volunteering with a group of people or by yourself?
(Our House is small and it's difficult to accomodate large groups, we ask that volunteer groups be no more than 10 people)

• With a group
• By myself

How many people are expected to volunteer?

Is this a group of adults or youth?
(Opportunities for 3rd graders and younger include coming to the House for a tour, baking, or making crafts for our families)

• Adults
• Youth

What date(s) would you like to volunteer?

How long do you plan to stay?

• Anything
• Clean
• Prepare evening meal / bake
• Yard work
• Other (please note below)

Other

What else would you like us to know?

Are you interested in becoming a regular volunteer or relief manager?
(If yes, RMH staff will contact you about different opportunities.)

• Yes
• No