First Name*

Middle Initial

Last Name*

Home Address*

Home City*

Home State*

Home ZIP*

Work Address

Work City

Work State

Work ZIP

Home Phone*

Work Phone

Fax Number

Cell Phone

Personal Email*

Work Email

Please indicate to which address you prefer to have your mail delivered:

HomeWork

May we fax or email you at work?

YesNo

May we add you to our e-newsletter mailing list?

YesNo

Current/Previous Social, Civic, or Community Involvement (note organization, position, and dates involved)

Areas of Interest* (Select all that apply)

Office AssistanceFood PantryKitchen/Dining RoomThrift Store/Furniture StoreTruck Driver/Furniture PickupDriver/Food Pickup Van

Sharing Center Hours of Operation

Office: Monday–Friday from 9:00 AM to 3:00 PM

Food Pantry: Monday–Friday from 9:00 AM to 3:00 PM

Thrift Store: Monday–Friday from 9:00 AM to 5:00 PM; Saturday from 9:30 AM to 1:30 PM

Please indicate the starting and ending hours you are available to work*:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Select all that apply*:

I wish to volunteer in the thrift storeI wish to volunteer in the kitchenI wish to volunteer in the officeI wish to volunteer as a driver

How did you hear about us?

When is your birthday? (month/day)

Do you sign or speak a second language? If so, please explain here.

Do you have any comments or information about you or your family you would like to share?

Please list any skills or talents you can bring to the sharing center.

Emergency Contact Information

Contact Name

Contact Phone

Relationship to Contact

Contact Address*

Contact City*

Contact State*

Contact ZIP*

*Required