Community Volunteer Application Form

Please complete this application form if you are interested in becoming a La Puente Home Inc. volunteer. Once you complete the form, click the submit button at the bottom.

Name and address

First name:

Last name:

Title:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Communication Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email and mail, however we will not send you any email or mail you prefer not to receive. Use the checkboxes below to select the kinds of mail you would like to receive from us.

What kinds of email would you like to receive?

Electronic newsletters

Schedule reminders

By Mail:

Quarterly Newsletter

Assignment Preference

Availability

Please indicate the days and times you are usually available to volunteer.

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

Are you 15 years old or older?

Volunteers under 15 will need to be accompanied by an adult.

Date of birth:

Age:

Mandated Service

Please indicate if you are completing mandatory service hours. If yes, select all options that apply.

I would like to serve up to:

hours:

Mandated Service:

Yes

Type of mandated service:

Criminal Offense

Have you ever been convicted of a criminal offense? If yes, please explain.

Criminal Offense:

Yes

Pictures

Please Indicate "yes" or "no" if La Puente Home Inc. can use pictures that may be taken of you for promotional purposes.

Can we use your picture?:

Yes

Emergency Contact

Please enter someone that we can contact in the case of an emergency.

First name:

Last name:

Home phone:

OK to call here

Cell phone:

OK to call here

Relationship:

Special Skills

Please check any skills that you have.

Volunteer Waiver Form

I certify that the information provided in this application is correct and complete. Furthermore, I understand that La Puente will not be held liable for any injury or illness that I, or my dependent(s), may suffer. I waive any such claim for compensation from this organization in the event of such injury.

I Agree