Bread of Life Outreach Program, Inc

Salutation

Mr.
Mrs.
Ms.
Dr.

Name

Address

Phone

E-mail

Do you have a driver’s license and are you able to drive?

Yes
No

Are you in good health and would you have any problems lifting boxes weighing around 20 to 30 pounds?

Yes
No

Would you be interested in solicitation by phone work to request donations of product that would be helpful to the needy?

Yes
No

Do you have any talents or professional expertise that could be a benefit in a crises situation, such as counseling, crises hotline work, plumbing, electrical work, carpentry, etc? Feel free to explain if you wish:

Are you free of any legal concerns that could hinder the security of our volunteer work?

Yes
No

If so, Please Explain: