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Volunteer Application

Personal Information

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Marital Status

Availability (Please check all that apply.)

Monday
Tuesday
Wednesday
Thursday
In which areas are you interested in voluteering? (Please check all that apply.)

Emergency Contact Information

Agreement and Signature

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, and false statements, omissions, or other misrepresentations made by me on this application may result in immediate dismissal.

I also realize that I am making a serious commitment to give a portion of my time and energy to assist Raphael Community Free Clinic as a volunteer.

I further agree to respect the privacy rights of all direct and indirect participants in any Raphael Community Free Clinic activities.

I also understand that either party has the option of terminating this volunteer relationship for any reason, expressed or not.

Thanks for submitting!

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