Group Volunteer Form

Group/Agency/Organization Name
Address
Phone
Primary Contact Name
Primary Contact Work Phone
Primary Contact Email
Would you like to receive PMN newsletter by email? Yes
Secondary Contact Name
Secondary Contact Work Phone
Secondary Contact Email
Would you like to receive PMN newsletter by email? Yes

EMERGENCY CONTACT INFORMATION: Please indicate below person to contact in case of emergency

Emergency Contact Name
Emergency Contact Primary Phone
Emergency Contact Address
Emergency Contact's relationship to you

VOLUNTEER INFORMATION

Number of individuals your group plans to bring to volunteer
What hours is your group available to volunteer?
Is your group interested in volunteering more than once?
Other Information
By checking this box, I(We) understand that all information regarding clients served by Providence Ministries for the Needy, Inc. is confidential and that I(we) am(are) obligated to maintain confidentiality. I(We) Agree