Night to Shine Volunteer Form

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Please fill out this field.

Address Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Parent Name (If under 18) Please enter valid data.

Parent Phone (If under 18) Please enter valid data.

Emergency Contact During Event (If under 18) Please enter valid data.

Emergency Contact Phone Number (If under 18) Please enter valid data.

A current background check is required for ALL volunteers over the age of 18.

I have had a background check within the last 12-18 months: Yes No

If yes, please provide Sacred Heart with a copy of your current background check as soon as possible.

If no, you will be required to complete a background check for the Diocese of Des Moines.

If you are under the age of 18, a permission slip signed by your parent/guardian is required to volunteer.

Special Skills/Training (please check all that apply): Fluent in American Sign Language (ASL) Special Education Teacher Healthcare Professional (if so, please list what field) Current Volunteer in Sacred Heart's St. Margaret's Ministry Other

Comments: Please enter valid data.

I have volunteered at a Night to Shine Event before: Yes No