First Name *

Last Name *

Mailing Address *

City *

State *

Zip Code *

Business or Organization

Daytime Phone Number

Evening Phone Number

Cell Phone Number

Email Address *

Are you certified in Basic First Aid/CPR?
YesNo

Are you 18 years or older?
YesNo

Are you willing to attend an Orientation/Training meeting prior to volunteering?
YesNo

How did you hear about the Egan Warming Center?

Please list any skills or volunteer/professional experience relevant to working with people.

Please indicate an area of interest...
Food & Hospitality
Set-Up
Safety
Resource & Support
Guest Intake
Scheduling
Shuttle Driver/Shuttle Driver Assistant
Behavioral
Medical/First Aid
Clean-up Crew

Please indicate the shift(s) you will most likely be available to work:
Setup Crew: 5:00 PM - 6:30 PM
SHIFT ONE: 5:30 PM - 10:30 PM
SHIFT TWO: 10:00 PM - 2:00 AM
SHIFT THREE: 2:00 AM - 6:00 AM
SHIFT FOUR: 5:30 AM - 8:00 AM
Clean-up Crew: 7:00 AM - 9:00 AM
Evening Transportation Hub Safety Crew: 5:00 PM - 10:00 PM
Morning Transportation Hub Safety Crew: 7:00 AM - 9:00 AM

Please list months and/or days you are NOT available (For example: from Nov. 15-Mar.1):

Do you have a site preference?
Valley Covenant (Eugene)
Trinity
Youth Site
Church of the Resurrection (South Hills)
Central Lutheran (Campus)
Lane Community College (Campus)
Wheeler Pavilion (Fairgrounds)

Additional Comments: