Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Date of Birth *

MM

DD

YYYY

Tell us in which areas you are interested in volunteering (check all that apply) *Certain outreaches have additional training and clearance requirements. Leadership has the right to terminate your participation in a particular outreach if they feel it is not a good fit. *

Serve Team (Volunteering at fundraising events)

Transportation Team (Appointments)

Gift Card Collection Drive

Beautification Team (Maintenance of house and yard)

Holiday/Birthday/Graduation Party Planning Team

Other

Preferred length of commitment to Magdalene House Austin: *

1 month

6 months

One year

More than one year

Other

Hours available to volunteer each month *

1-5 hrs

5-10 hrs

10-15 hrs

Other

Emergency Contact Number *

(###)

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Checkbox 1 *

By checking this box you affirm that the facts herein are true and complete. I understand that if I am accepted as a Magdalene House volunteer any false statements, omissions, or other misrepresentations made on this application or references may result in my immediate dismissal. I understand that Magdalene House is not obligated to provide a reason for their decision in accepting or rejecting me as a volunteer.

I affirm these facts are true and complete.

Please provide your name again as a form of a signature *

First Name

Last Name

Today's Date *

MM

DD

YYYY