GFCFS Website Volunteer Application

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

Our Policy:
It is the policy of Goochland Free Clinic & Family Services to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Thank you for completing this application form and for your interest in volunteering with us.

Download this application as a PDF file.

* Required information.

Full Name: *

Email Address:

Street Address: *

City, State, Zip Code *

Home Phone: *

Work Phone:

Cell Phone:

Date of Birth: *

Start Date: *

When are you available for volunteer assignments? *

Weekday mornings

Weekday afternoons

Weekday evenings

Please tell us in which areas you are interested in volunteering. *

Administration

Events

Fundraising

Professional

Please summarize special skills and qualifications you have acquired. *

Please summarize your previous volunteer experience.

Name of Person to Notify in Case of Emergency:

Their Street Address:

Their City, State, Zip Code

Their Home Phone:

Their Work Phone:

Their Email Address:

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