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2. First Name
3. Last Name
5. Date of Birth
7. Address
9. City
10. State
11. Zip Code
13. Cell Phone Number
14. Home Phone Number
16. Email Address
18. Preferred Method of Contact
    -- Select One --Cell PhoneHome PhoneEmailMail
20. Emergency Contact Name
21. Emergency Contact Phone Number
23. How often are you interested in volunteering?*
    -- Select One --WeeklyMonthlyA few times a year
24. General Availability*

    1. Monday Daytime
    2. Tuesday Daytime
    3. Wednesday Daytime
    4. Thursday Daytime
    5. Friday Daytime
    6. Saturday/ Sunday

    1. Monday Evening
    2. Tuesday Evening
    3. Wednesday Evening
    4. Thursday Evening
    5. Friday Evening
26. Vehicle/ Driver's License
    -- Select One --YesNo

    Some volunteer tasks require a vehicle and current driver's license. Would you be willing to utilize your personal vehicle as part of your volunteer activities?

28. Areas of Interest

    1. Parks/Playgrounds
    2. Natural Areas
    3. Senior Services
    4. E.D. Locke Public Library
    5. Public Safety
    6. Community Events
    7. Village Committees
    8. Clerical Assistance
30. Current Volunteer Programs

    Following is a list of current volunteer opportunities. Select which may be of interest to you.

    1. Village Committee Membership
    2. Adopt a Fire Hydrant
    3. Woodland Restoration
    4. Adopt a Playground
    5. Meals on Wheels Delivery Driver
    6. Senior Nutrition Program Kitchen Assistant
    7. E.D. Locke Library Book Sale
    8. Community Service Day Event Planning
    9. Office Help
    10. Drier Escort for Senior Medical Appointments
    11. Grave Restoration at McFarland Cemeteries
32. Skills, expertise or abilities that you would like to share through volunteerism.
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field