Full Name:

Address:

City:

Birthdate:

Skills or Experience:

How would you like to help?

Availability:

Phone:

Email:

Emergency Contact Name:

Emergency Contact Phone:

You must be at least 18 years old to volunteer at SMHC. Because volunteers interact with clients and may have access to confidential client information, we perform background checks on all volunteers. Volunteers must protect the rights and privacy of our patrons. All organization records, files and information is privileged and not to be accessed, discussed or distributed. As a potential volunteer I affirm that I am at least 18 years old and will abide by the confidentially rules above.

Confirmation:
I confirm I am at least 18 years old and agree to abide by confidentiality rules

Signature:

Date: