Norton Women and Children's Family Room Volunteer Application

Please complete this application form if you are interested in becoming a Ronald McDonald House Charities of Kentuckiana volunteer. Once you complete the form, click the Continue button at the bottom.

Contact Information

First name:

Last name:

Title:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

Work phone:

OK to call me here

Cell phone:

Email address:

Personal Information & Emergency Contact

Please list your date of birth and gender. Then provide one person we can contact in case of an emergency.

Date of birth:

First name:

Last name:

Home phone:

Cell phone:

Relationship:

Availability

Please indicate the days and times you are usually available to volunteer. Shifts run 9A-12P, 12P-3P, 3P-6P

Skills and Experience

Please list prior volunteer experience, your skills, and any physical limitations.

Why are you interested in this opportunity?

Please let us know why you are interested in volunteering at the Ronald McDonald Family Room and what you hope to get out of your time with us.

PLEDGE OF CONFIDENTIALITY

I hereby pledge that I shall safeguard and treat as CONFIDENTIAL all information (whether acquired through verbal communication, written record, or observation) pertaining to any resident, staff member, or Volunteer of the Ronald McDonald Family Room, which I may, through my affiliation with the Family Room, so acquire.

I have read and do understand the foregoing pledge of confidentiality.

I Agree