National Shrine of The Divine Mercy
Volunteer Registration Form

General Year Round Volunteer

NOTE:

You must be at least 18 years old to volunteer.
You must be at least 16 years old to volunteer
with adult supervision.

Title:

*First Name:

Middle Name:

*Last Name:

Suffix:

*Address:

*City:

*State/Province:
(If none, please enter "None")

*Zip/Postal Code:

*Country:

*Home Phone:

Work Phone:

Cell/Mobile Phone:

*E-mail Address:

Current Occupation:

Language(s) Spoken:

Are you an employee
of Eden Hill?

Yes No

Are you a Knight of Columbus?

Yes No

Additional Information: