Phone: Home/Cell xxx-xxx-xxxx:
Are you between the ages of 14-17 years old?
Emergency Contact Name:
Emergency Contact Phone xxx-xxx-xxxx:
How did you hear about the volunteer opportunities at Harbor House?
List activities you are presently involved in:
Do you speak Spanish?
Do you speak Hmong?
Why do you want to volunteer for Harbor House Domestic Abuse Program? (You may check more than one.)
Because my school requires it. How many hours required:
I want something to do outside of school and family activities
I want to learn more about domestic abuse
I have been encouraged to do so by others. Who:
Please list three. Name/address/phone number xxx-xxx-xxxx/relationship
For Grant and statistics purposes only
American Indian/Alaskan Native
Native Hawaiian/Other Pacific Islander
American/Indian/Alaskan Native & White
Asian & White
Black/African American & White
American Indian/Alaskan Native & Black
If other Multi-Racial, please list:
Do you have a disability?
The primary purpose of the Harbor House Domestic Abuse Programs is to provide protection and safety to victims and the children of victims. The use or disclosure of any information by anyone affiliated with Harbor House (staff, volunteers, board members) that concerns the victims or the children of victims who receive services from Harbor House for any purpose is prohibited by state law. It is, therefore, a policy of the Harbor House Domestic Abuse Programs that any agent of Harbor House (staff, volunteers, board members) will treat all contacts and information regarding victims and children of victims who receive services from Harbor House as confidential.
No information Regarding service recipients will be divulged either directly or indirectly to anyone.
CONFIDENTIALITY PLEDGE AND AGREEMENTS:
By clicking the submit button: