Extra Hands for ALS

Extra Hands for ALS - San Francisco Bay Area Chapter - Mentor Registration

Thanks for your interest in Extra Hands for ALS. This form is for adult volunteers. If you are interested in registering as an Extra Hands student volunteer or as an ALS Family, please click here:

We're looking forward to meeting you!

Contact Information

First Name *

Last Name *

Email *

Phone Number *

(xxx) xxx-xxxx

Cellphone Number

(xxx) xxx-xxxx

Street Address

City

State

Zip

Identity

Race:

Gender:MaleFemale

Birthdate: *

Employer:

Occupation:

Emergency Contact Information

Full Name *

Relationship To You

Email *

Phone Number *

(xxx) xxx-xxxx

Cellphone Number

(xxx) xxx-xxxx

Motivation

Why would you like to volunteer with Extra Hands? *

If you know or have known someone with ALS, please explain.

If you know or have known someone with a terminal illness, please explain.

Have you experienced the death of a loved one or someone you knew personally?

Do you have experience mentoring and/or working with teens?

Do you have any other experiences, training or education that make you a good candidate to be a volunteer?

Policies

Extra Hands for ALS adheres to a strict policy prohibiting sexual molestation, abuse, and harassment. Both volunteers and patients have the right to request being matched with someone of a particular gender. All parties must read and agree to Extra Hands for ALS policies before participating. If you have any questions or concerns in this regard, or if you have any other special considerations, please indicate so on this form or contact us at the numbers above.



Contact us in: Boise \| Dallas-Ft. Worth \| Denver \| Los Angeles \| New England \| New Jersey \| Orange County \| San Francisco Bay Area \| St. Louis \| Westchester



Copyright © 2002 - 2008 Extra Hands for ALS (except as noted)	About Us Contact Us Privacy Policy