Volunteer Kit Registration

Please fill out the form below to become a volunteer with Cuddle My Kids! Step #1
First Name	Last Name
Address
City	State   - Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississipi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip	Phone       Cell Phone
Email Address
Step #2
Do you have a valid Driver's License, insurance & access to a car?   - Select - Yes No
Do you have experience with children?   - Select - Yes No
Do you have experience with cancer patients?   - Select - Yes No
Step #3
Interested in volunteering on scheduled Home Visits?   - Select - Yes No Maybe
Interested in volunteering to drop off Cuddle Bags?   - Select - Yes No Maybe
Interested in helping with administrative/office duties in the office?   - Select - Yes No Maybe
Interested in helping with Fund Raising Activities?   - Select - Yes No Maybe
Interested in acting as a Back-Up Volunteer when necessary?   - Select - Yes No Maybe
Interested in sharing other skills that might be helpful? Please list below:
Please check the days you are available: Monday   Tuesday   Wednesday   Thursday   Friday
Please check your preferred times: Mornings   Afternoons
Step #4: Please complete the References section below.
First Name	Last Name
Address
City	State   - Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississipi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip	Phone       Cell Phone
Relationship
First Name	Last Name
Address
City	State   - Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississipi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip	Phone       Cell Phone
Relationship