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2. Date*
   Date
4. Name*
5. Email Address*
7. Physical Address*
9. PO Box Address
11. City*
12. State*
13. Zip Code*
15. Primary Number*
16. Secondary Number
18. Date of Birth*
    Date of Birth

    For Placement purposes only.

19. Volunteer Selection*
    -- Select One --AdministrationCity Boards and CommissionsCommunity & Neighborhood ServicesFire DepartmentMain Street & TourismParks & RecreationPlanning & Development ServicesPolice DepartmentPublic WorksSupport Services

    Department Choices

20. Days Available To Volunteer*

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday
    5. Thursday
    6. Friday
    7. Saturday
21. Preferred Hours*
    Preferred Hours Start Time

    —

    Preferred Hours End Time
23. Emergency Contact Name*
24. Emergency Contact Phone*
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

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