Full, Legal Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Have you been charged with or convicted of a felony within the past 5 years? *

Yes

No

Have you ever been employed by JIS? *

Yes

No

Are you a current or former client at JIS? *

Yes, current client

Yes, former client

No

Have you ever been charged with child abuse, assault, or sex offenses of any nature? *

Yes

No

Emergency Contact - Phone Number *

(###)

###

####

I am interested the following volunteer opportunities: *

Adopt a Meal (Cater or Prepare a meal)

Birthday Celebration

Child Care

Christmas Client Adoption

Front Desk Receptionist

Holiday & Special Occasion Cooking

Kitchen Help

Lend a Hand

Pantry & Storage Room Organizer

Party Evening

Serve a meal

Other

I agree to the terms and conditions linked above this form. I understand that these policies are in place for the safety of the volunteers, guests, and staff of JIS. If I am in violation of them, I understand that I can be immediately dismissed from volunteer service for JIS. My typed signature is considered a legal, handwritten signature on this form submission. *