Name:

Employer:

Work Phone:

Home Phone:

Email:

Emergency Contact Number:

Areas of Volunteer Intrest:

Organizational or Civic Affiliation:

How did you learn about Columbus House?

I hereby agree to treat the clients, staff and fellow volunteers of Columbus House in a respectful and dignified manner at all times. I agree to keep all client information in the strictest confidence. Should I witness or become aware of an accident, altercation or other unforeseen incident needing immediate attention, I will report to a Columbus House staff member as soon as possible. By signing, I agree to abide by the Volunteer Guidelines on the back of this form.

I agree to these terms