Home
Leadership/Governance
Departments
Free Clinic
Food Pantry
Food Department Pictures
Family Development
Christmas for the Love of Children Pictures
Education Department
Summer Camp Photos
Events
Calendar
Volunteer
Application Form
Blog/News
Publications
Support OPEN M
Contact
Directions
We Design With Modesty
Volunteer Application Form
We would love to hear from you! Please fill out this form and we will get in touch with you shortly. Please be advised that if you are volunteering to work with children, you are giving us permission to do a background check by completing this form.
Name
*
First
Last
Gender
*
Male
Female
Address
*
Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code
How long have you been at this address?
*
Best Phone Number to Reach You
*
Work Phone (If you can be contacted at work.)
Cell Phone
Email Address (If you can be contacted by email.)
Birthdate (mm/dd/yyyy)
Please check all areas you are willing to volunteer.
Medical-Dental Clinic
Sports & Recreation
Food Pantry
Hot Lunch Program
Server at Special Events
Building Upkeep
Gardening
Driver
Thanksgiving Dinner
Clerical-Office Help
Mountain of Food Giveaway
Receptionist
Summer Program
Christmas Program
If interested in being a clinic volunteer are you:
A licensed professional
Medical student
no medical experience
List any clinic specialities that apply to you
Tell us when you are available to volunteer. What days and hours are best for you?
Section Break
In Case of Emergency Please Contact
First
Last
Relationship
This Person's Home Phone
This Person's Work Phone
This Person's Cell Phone
Your Family Physician
Your Physician's Phone Number
Follow Us!