Volunteer

Name*
First Last
Date of Birth*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Emergency Contact Name*
Emergency Contact Number*
Church, School, or Organizational Affiliation
Have you volunteered at Talbot House Ministries before?*
- Yes
- No
Is your community service court-mandated or required by another organization?*
- Yes
- No
If YES, please explain
Have you taken a tour of Talbot House Ministries before?*
- Yes
- No
Have you ever been a client of Talbot House Ministries?*
- Yes
- No

Good Samaritan Free Clinic
- Doctors
- Nurses: health screening, taking vitals, etc.
- Pharmacists
- Dentists
- Dental Hygienists
- Dental Assistants
Additional Information:
- I understand that my work with Talbot House Ministries is fully voluntary. I am receiving no pay or compensation for my services and time. Further, I agree to hold Talbot House Ministries harmless for any accidents or situations that occur that cause damage or liability to myself or others. Further, I agree to allow Talbot House to use any images or pictures taken of me during my work here for social media purposes or other promotions.
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VOLUNTEER