Habitat for Humanity of Mahoning Valley

Habitat for Humanity of Mahoning Valley Volunteer Application

What's your email address?

We need your email so we can communicate with you.

Your information

Required fields are marked with an asterisk (*).
Birthdate *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
First Name *
Last Name *
Mobile Phone *

For example, 123-456-7890
T-Shirt Size *
Address *
City *
State *
Zip Code *
Emergency Contact Name *
Emergency Contact Number *
Retired *
Employer (please type N/A if not applicable) *
Occupation (please type N/A if not applicable) *
Clubs/Organizational/Church Affiliations
School (if under 18) *(PLEASE TYPE N/A IF NOT APPLICABLE)* *
Grade (if under 18) *
Volunteer Interests

I further AGREE ______ DO NOT AGREE ______ to allow any photos taken of me at HFHMV events to be used for HFHMV purposes. *
I represent that I have medical insurance on my own with ____which will cover any and all injuries or medical conditions which must be treated in connection with any and all accidents related to working as a volunteer on a HFHMV project or in a ReStore.