Online Application – Milwaukee Rescue Mission

Name (First Name, Middle Initial, Last Name) *
Street Address *
City *
State *
Zip Code *
Home Phone *
Cell Phone
Email Address *
Date of Birth (mm/dd/yyyy) *
Will you be fulfilling a class requirement?	Yes No
If yes, how many hours of volunteer service do you need complete?
Will you be fulfilling court ordered community service through this volunteer opportunity?	Yes No
Have you ever been convicted of a felony?	Yes No
Have you ever been accused of child neglect or abuse?	Yes No
Do you use illegal drugs?	Yes No
Is there any circumstance that we should be aware of regarding your ability to be trusted with children or young people?	Yes No
If yes, please explain
What area(s) of volunteering are you interested in? (tutoring, nursery, clothing room, meal serving, providing bagged lunches)