Volunteer Registration
 
Name: _________________________________________________
             Last             First         Middle
 
Address: ______________________________________________
            Street                           Apt.
 
         ______________________________________________
             City            State         Zip Code
 
Telephone: (_____)____________
 
FAX:       (_____)____________    
 
E-mail     _____________________
 
Date of Birth:  ______/______/______  
 
Marital Status:________________  
 
Children:_______________
 
Adoption Triad Relationship (If Applicable):
     ____ Adoptee ____Birth Parent ____Adoptive Parent
 
     Other _______________________
 
Occupation: _______________________________________
 
Soc. Sec. # ______-_____-______         
 
Driver's License # ________________________________
 
Skills/Certifications
 
______________________ 
 
______________________ 
 
______________________ 
 
______________________ 
 
______________________ 
 
______________________ 
(Use reverse as needed)
 
 
 
Interests/Hobbies
 
______________________ 
 
______________________ 
 
______________________ 
 
______________________ 
 
______________________ 
 
______________________ 
(Use reverse as needed)
 
 
 
Organizations/Memberships
 
______________________ 
 
______________________ 
 
______________________ 
 
______________________ 
 
______________________ 
 
______________________ 
(Use reverse as needed)
 
I certify that I will represent Chosen Children's Charities, Inc. and its missions truthfully and forthrightly to the best of my ability; that any and all funds raised on behalf of CCC, Inc. will be forwarded to the main office in atimely manner; and that my volunteer hours spent on behalf of CCC, Inc. will be reported to the main office on a
monthly basis.
 
 
___________________           _____________________
Date                          Signature