Volunteer Questionnaire Form


First Name:
Last Name:
Street Address:
Zip Code:
Email Address:
Home Phone #:
Cell Phone:
Emergency Contact Person:
Emergency Contact Phone#:
Date of Birth:
 /  / 

Are you willing to volunteer with any of the 3 groups listed below?

Habitat for Humanity
Faith in Action

Please check each activity you are either skilled in or willing to work in.

Repair Work

Special Needs: for example, if you have any dietary issues, please list here.
Vehicle(s): for example - pickup truck, van etc. Please list here:
Word Verification:

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Serving Ashtabula County Since 2011 H2O Missions is a faith-based, interdenominational, nonprofit organization that provides volunteer home repairs for disadvantaged residents of Ashtabula County.