Thank you for your interest in volunteering with The Woodies!

Please note that at this time, our roster is full; however, you may complete the form below and we will reach out when we need more helping hands. Alternatively, contact us to find out more.

Volunteer Name *

First

Last

Address *

Address Line 1

Address Line 2

City

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Zip Code

Phone *

Email *

Emergency Contact *

First

Last

Emergency Contact Phone *

Next of Kin

First

Last

Next of Kin's Relationship to Volunteer

Next of Kin Phone

Primary Medical Insurance Provider *

Insured's Name *

First

Last

Insured's Relationship to Volunteer *

Medical History (check all that apply) *

• Heart Disease
• Hypertension
• Diabetes
• Lung Disease
• Asthma
• Back Disorder
• Convulsive Disorder
• Episodes of Loss of Consciousness
• Allergies (please specify below)
• Other

Other Medical History/Known Allergies (if applicable)

Medications including OTC (if applicable)

Medication Allergy (specify medication and type of reaction)

I certify the above information is true and correct (as of this date) to the best of my knowledge and authorize its release to any medical personnel caring for me in an emergency. *

First

Last

Date / Time

Date

Time

Submit