Volunteer Package

The information gathered here is STRICTLY CONFIDENTIAL and is used to exclusively for The Cythera Volunteer Program.

Name *
Name
Address
Address
Primary Phone Number *
Primary Phone Number
Secondary Phone Number
Secondary Phone Number
Are you 15 years and older? *
Volunteers must be at least 15 years of age to volunteer at our Children's Boutique.
Are you willing to have a Criminal Record check completed? *
Cythera mas ask for a Criminal Record Search.
Current or former, if retired.
If you are a student
Do you have any allergies, physical limitations or do you take any medications that Cythera personnel should be aware of?
Please provide a name, phone number and their relationship to you
Do you have your own transportation? *
Have you received services in the past 2 years from Cythera Transition Society *
If so please indicate the type of services received:
If yes, please provide information relating to the date and capacity.
Please provide details regarding the agency, dates and duties performed.
Education *
Please provide information regarding your highest level of education completed.
Where did you hear about us? *
Training, Skills & Experience *
Please provide the names and phone numbers for two references.
Morning Availability *
Which days of the week are you available to volunteer from 9am-1pm?
Afternoon Availability
Which days of the week are you available to volunteer from 1pm-5pm?
Please tell us why you chose our agency to volunteer with us *