NEW VOLUNTEER SIGN-UP FORM

To participate as a volunteer for URHS, please fill out the following form to provide us with your personal information, as well as your primary point of contact in the event of an emergency. Please provide at least one emergency contact, and the phone number at which that person can most easily be reached.

Volunteer Sign-Up Form

Volunteer Name

First Name

Last Name

Volunteer Phone

(###)

###

####

Volunteer Email

Volunteer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Volunteer Birth Date

MM

DD

YYYY

Medical Info

Do you have any pertinent medical information or allergies that you would like to make known, if the event of an emergency?

Emergency Contact Name

First Name

Last Name

Relationship

Emergency Contact Phone

(###)

###

####

Emergency Contact Email

Emergency Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Secondary Emergency Contact Name

First Name

Last Name

Secondary Emergency Contact Relationship

Secondary Emergency Contact Phone

(###)

###

####

Secondary Emergency Contact Email

Secondary Emergency Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

About You

For new volunteers, what should we know about you? Do you have any skills that you think would be useful to URHS? Is there anything in particular you would like to be involved in?