Kids First

Name

Phone

Mailing Address

Address Line 1

Address Line 2

City

State: Select OneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code

Email

*Birthdate (i.e. xx/xx/xxxx)

*Gender: MaleFemale

*Social Security Number: For your privacy and safety we will call the phone number provided above to retrieve this information.

Volunteer Opportunities: (please check all you are interested in)

Filing/clericalSCAN (school prevention program)Sitting with kids prior to appointmentsNewsletterChristmas PartyBack to School BashSoliciting for itemsFundraising

Do you want a reminder email or call? EmailCall

Days you can volunteer: (check all that apply) MondayTuesdayWednesdayThursdayFriday

How often can you volunteer? WeeklyBi-WeeklyMonthly

As a volunteer for the Child Advocacy Center you may have access to certain information concerning clients of the CAC. When you become a volunteer you will be asked to sign a confidentiality agreement. By signing this agreement you agree to abide by this confidentiality policy while you are an active volunteer and after your volunteer service has ended.

I Agree

*NOTE: This information in necessary to authorize the Department of Children’s Services, the National Child Abuse Registry and Police Departments to release any information in their files under the above name and description. This information will be used to assist the Child Advocacy Center in determining eligibility to serve as a volunteer.