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?
 Yes No

Are you 18 years or older?
 Yes No

Are you willing to attend an Orientation/Training meeting prior to volunteering?
 Yes No

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: