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* 1. Contact Information

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* 2. Date of Birth:

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* 3. Health Status:

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* 4. Do you have any physical limitations?

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* 5. Education:

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* 6. Work Experience:

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* 7. Have you ever been convicted of a crime?

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* 8. Emergency Contact (Name & Number)

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* 9. Have you ever volunteered with HMC before?

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* 10. Please select the volunteer category that you are interested in:

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* 11. Please indicate the days and times you are available to volunteer.

  7 am - 11 am 12 noon - 4 pm 5 pm - 9 pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

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* 12. Please select your t-shirt size.

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* 13. Do you have any underlying health conditions?

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* 14. Why are you interested in volunteering?

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* 15. Please select which departments you are most interested in:

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