Good Samaritan Registration

Please fill out this form and click submit.

Name

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Email

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This address will receive a confirmation email

Phone

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Address

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Other Information

Areas of Interest

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Please select all that apply.

Helping the elderly Assisting with shopping Mechanically inclined Hospitality Prayer Team Other

If you selected

Skills/Talents Please list any skills or talents you would like to contribute:

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Briefly describe why you would like to participate in the Good Samaritan program:

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Do you have any previous experience in volunteering or community service? If yes, please provide details

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Please choose One

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Please select one option.

I enjoy working in a team setting I prefer individual tasks

Are there any specific tasks or projects you would like to work on? If yes, please provide details:

Is there anything else you would like us to know?

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Availability

Time of Day

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Please select all that apply.

Mornings Afternoon Evenings Open

Days available

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Please select all that apply.

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Description

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