Dream Center of Pickens County

Volunteer Application

Applicant Name: *
Date of Birth: *
Last Four Digits of SSN:
Date Available: *
Address: *
Home Phone:
Mobile Phone:
Work Phone:

Emergency Contact Information

Primary Contact Name: *
Primary Contact Home Phone: *
Primary Contact Mobile Phone: *
Primary Contact Work Phone: *
Secondary Contact Name: *
Secondary Contact Home Phone: *
Secondary Contact Mobile Phone: *
Secondary Contact Work Phone:

What day(s) are you available for volunteering?
Which area(s) are you interested in volunteering?
List other volunteer area(s) you are interested in not listed above:

Consent - Photographic Release

I hereby authorize The Dream Center of Pickens County to release any photographs

taken of me for any purpose related to the promotion and well-being of

The Dream Center of Pickens County including,but not limited to

newspapers, magazines, presentations and television.

I Consent: *

Consent - Disclaimer and Signature

By electronically submitting this application I affirm, agree, and understand that all statements on this volunteer application are true and accurate.

I also grant permission to the The Dream Center of Pickens County to check with appropriate authorities upon matters of record regarding my background or history.

I understand The Dream Center of Pickens County is a faith based non-profit organization operating with Christian beliefs and values.

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