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Volunteer Application
Contact Information
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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(mm/dd/yyyy)
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Skills and Interests:




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Availability

Personal Data
**We will need a copy of a government issued ID (such as a driver's license).

If you have a digital copy of your government issued ID, you may upload it here.
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References
List the names, addresses, phone numbers, and email addresses (if applicable) of three personal references, other than relatives:



Client Confidentiality/Protection Pledge/Emergency Treatment
Please read the following statement carefully:

Maintaining the confidentiality of the residents of Providence House and their families is of the utmost importance. As a volunteer, you will be expected to abide by this organization's policy to protect the confidentiality of those who live here. In agreement with this policy, I pledge to honor the privacy and uphold the confidentiality of each resident/child at Providence House. Providence House reserves the right to obtain a criminal background and social security number check. If I should become ill/injured, I authorize Providence House to arrange emergency treatment and I accept responsibility for payment of medical services rendered. 

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Please type your name as your digital signature.