Volunteer Application

First name

Last name

Email

Phone

Address

City

State

Zip

Birthday

Month

Day

Year

Are you over 18 years of age?

Yes

No

Emergency Contact

Emergency contact phone #

Church Affiliation

Active Church Member?

Yes

No

Occupation

How did you hear about the center?

What do you know about our mission?

What volunteer position(s) are you interested in? (Please list special skills/gifts or experience you may have.

How many hours per week would you be able to commit to?

Please give a summary of your Christian beliefs and how you were led to pro-life ministry.

Please list all pro-life activities, participation in other ministries, and any organizations you belong to.

Why do you want to volunteer?

Under what circumstances do you feel abortion may be justified?

Do you know anyone who has had an abortion?

We do not offer, recommend, or refer for abortions, abortifacients, or contraceptives. We are committed to offering accurate information about related risks and procedures. Are you able to agree with these standards?

Yes

No

Are you willing to sign our Statement of Faith/Code of Christian Conduct?

Yes

No

Please list 3 references:

Reference 1

First Name & Last Name

Phone Number

Reference 2

First Name & Last Name

Phone Number

Reference 3

First Name & Last Name

Phone Number

Medical Insurance Waiver (Please choose one)

I carry adequate medical insurance and I accept full responsibility for medical costs associated with an injury while volunteering at the center.

I do not carry medical insurance and I accept full responsibility for medical costs associated with an injury while volunteering at the center.

Insurance Carrier (if applicable):

I certify that the information contained in this application is true, correct, and complete. I understand that if chosen to volunteer, false statements reported on this application may be considered sufficient cause for dismissal.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Contact Our Center

Hours of Operation