Health & Comfort Volunteer Intake Form

First Name *

Last Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Home Phone

Cell Phone

Email Address *

Best method to contact you *EmailHome PhoneCell Phone

Are you 18yrs or older? *YesNo

Birthday *

Age *

Do you have a valid driver’s license? *YesNo

Do you have reliable transportation? *YesNo

Emergency Contact Name *

Relationship *

Emergency Contact Home Phone

Emergency Contact Cell Phone

Emergency Contact Email Address *

What is your availability

As neededDailyWeeklyMonthly

or Once(specific date)

or Custom

I am willing to help with:

Event assistant tasks (volunteering at DVNF events)Putting hygiene kits together for at-risk VeteransAnything

How many hours per volunteer day are you available?

What time works best for you?

Early morningMid-morningAfternoonEvening

or Specific time

What specific skills do you have?0 / 180

Electronic Signature *

I understand that checking this box and submitting this form signifies my signature.

All of the information provided above is held to be true and accurate to the best of my knowledge.

Volunteer Name *

Parent or Guardian Name

Disabled Veterans National Foundation

The Disabled Veterans National Foundation (DVNF) provides critically needed support to disabled and at-risk veterans who leave the military wounded—physically or psychologically—after defending our safety and our freedom.

CONTACT

Email: info@dvnf.org
Phone: (202) 737-0522

Disabled Veterans National Foundation
4601 Forbes Blvd. – Suite #130
Lanham, MD 20706

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