Parish Disaster Response Volunteers

Name of Your Parish REQUIRED Please fill out this field. Please enter valid data.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Occupation REQUIRED Please fill out this field. Please enter valid data.

Specialized Training, Education or Skills You Possess

Willingness to Provide Food/Water/Necessities to Others REQUIRED I am willing to shop for those in need. I am willing to deliver items to those in need. I am willing to distribute food at food distribution sites. I am willing to run errands as needed. Other Please fill out this field.

Are you willing to use your own vehicle to deliver food, medicine or other items to those in need? REQUIRED Yes No Please fill out this field.

Preferred Days to Volunteer REQUIRED Sunday Monday Tuesday Wednesday Thursday Friday Saturday Please fill out this field.

Preferred Times to Volunteer REQUIRED Early Mornings 5AM - 8AM Mornings 9AM - 11AM Afternoons 12PM - 3PM Evenings 4PM - 7PM Nights 7PM - 10PM Please fill out this field.

Include Any Additional Comments on Your Availability to Help Here

SAFE ENVIRONMENT COMPLIANCE

While compliance with the Diocese of Lexington's Safe Environment is not mandatory for all volunteer aspects, it is necessary if you are working with children. Your parish or the diocese can help you become compliant.

Safe Environment Compliance Policy REQUIRED I understand that to volunteer with minors, I need to be "Safe Environment Compliant" and will ensure that I am by checking with my parish office before volunteering with minors. Please fill out this field.