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Volunteer Community Resource Provider
*
Please list your contact information
(Required.)
Name
City/Town
Email Address
Phone Number
*
What City or Cities are you willing to volunteer in?
Please check all that apply
(Required.)
Climax
Crookston
East Grand Forks
Erskine
Fertile
Fisher
Fosston
Smaller Surrounding Communities
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What services are you willing to provide?
Check all that apply
(Required.)
Deliver Meals
Deliver Medications
Grocery Shop for residents
Work at Food Shelf
Provide Transportation
Other (please specify)
*
What Hours are you willing to work?
Check all that apply
(Required.)
AM
PM
*
I understand that I am volunteering on my own free will and not on behalf of Polk County Public Health.
(Required.)
Agree
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