Volunteer Form for 2017 Name* First Last Have you ever filled out our thorough volunteer form on line.*YesNoEmail* Primary Phone*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you 18 years or older?*YesNoParent/Guardian Name*Parent/Guardian Contact Number*Will you be bringing any of your own children to volunteer with you?YesNoPlease list the names and ages of your children that will be coming with you to volunteer.To add additional names, click the "+" sign.NameAge EMERGENCY INFORMATIONLocal Emergency Contact* Name Emergency Phone*Relationship*Insurance Company/Policy NumberPrimary DoctorDoctor's PhoneMANDATORY QUESTIONSHave you ever been convicted of a criminal offense (felony or misdemeanor, except minor traffic violations)?*YesNoPlease explain:*Have you ever been reported to a social services agency, law enforcement authority, child abuse registry, or similar organization regarding abuse or misconduct involving children?*YesNoPlease explain:*Are there any other facts or circumstances in your or your background that would cause us to question your ability to supervise, guide and care for young people?*YesNoPlease explain:*Do you have any friends or family members who volunteer for Mansion Memories?*YesNoPlease provide their name and phone number as a personal reference.*Please provide the name and phone number for a personal reference.*VOLUNTEER PREFERENCESPlease indicate which program(s) you would like to volunteer for:Select all that apply Mansion Munchkins Magical Days Mansion Tour Paint & Sip Welcome Back Events - for Magical Day Families If you speak any language other than English, please list here:Please list any special skills, interests or hobbies you can share with our program:We will contact you before the events you have signed up for and find out how you want to volunteer at that time. By submitting this online Volunteer Form, you are releasing all information contained herein to the use of the Mansion Memories volunteer program.