Volunteer Application Personal InformationName First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mobile PhoneHome PhoneEmail Date of Birth MM DD YYYY Volunteering InformationHow did you hear about this volunteer opportunity? (please be specific)In which areas are you interested in volunteering? Receptionist Providing a Meal Special Events Housekeeping Maintenance Marketing/Fundraising Other (please specify below) If other, please specify here:Do you have special skills that might benefit the House? (marketing, finance, database, foreign language, writing skills, data entry, etc.)In-House Volunteers at the Ronald McDonald House are appreciated during the following hours: Sunday-Thursday 10am-8pm & Friday-Saturday 10am-4pm. When would you like to volunteer? (please be aware that dates and times of a volunteer opportunity are subject to the Ronald McDonald House calendar of activities.)DayFromTo Add as many days as you like.How often would you like to volunteer?WeeklyBiweeklyMonthlyQuaterlyEmergency ContactName First Last RelationshipPhoneCertificationHave you ever been convicted of a crime identified as a misdemeanor or felony?YesNoIf yes, please explain.By submitting this form, I certify that the information I have provided on this application is true to the best of my knowledge and agree to respect te families' right to confidentiality during and after my time at Ronald McDonald House Charities of Mississippi. I also understand and agree on behalf of myself and/or my child that RMHC, its staff, board of trustees, volunteers and others associated with RMHC will not be responsible or liable under any theory of liability for any claims, losses, damages, or injuries of any kind or nature, including, without limitation, any loss of or damage to our valuables, or other personal property from any cause, and/or for any personal injuries, illness, or death to us (or any of us) from any cause. I hereby grant RMHC and its local chapters and programs the irrevocable, unrestricted right to use, publish, display or distribute materials bearing my name, voice, likeness or any other identifiable representation of myself. These materials may appear in any form, style, color or medium whatsoever now or hereafter known. Electronic SignatureSignatureDate Applicants under the age of 18 must have this application signed by their parent or guardian. This applicant has my permission to volunteer at the Ronald McDonald House Charities. Parent/Legal Guardian SignatureDate This iframe contains the logic required to handle AJAX powered Gravity Forms. Thank you for supporting Ronald McDonald House Charities of Mississippi and the children and families that we serve.