Volunteer Community Resource Provider

Question Title

* Please list your contact information

Name

City/Town

Email Address

Phone Number

Question Title

* What City or Cities are you willing to volunteer in?
Please check all that apply

Climax

Crookston

East Grand Forks

Erskine

Fertile

Fisher

Fosston

Smaller Surrounding Communities

Question Title

* What services are you willing to provide?
Check all that apply

Deliver Meals

Deliver Medications

Grocery Shop for residents

Work at Food Shelf

Provide Transportation

Other (please specify)

Question Title

* What Hours are you willing to work?
Check all that apply

AM

PM

Question Title

* I understand that I am volunteering on my own free will and not on behalf of Polk County Public Health.

Agree