Volunteer Application

Online Volunteer Application - Hampton Roads Ecumenical Lodgings and Provisions, Inc.volunteer-hands1

"Serving Those In Need Since 1982"

 

HAMPTON ROADS ECUMENICAL LODGINGS & PROVISIONS, INC.1320 LaSalle Ave. Hampton, VA 23669  (757) 727-2577 

See Medical Clinic for hours or Dental Clinic for hours
If you are a medical or dental professional, please know that we will need to see a copy of your credentials.  Downloaded Applications may be returned by mail to:  H.E.L.P. Inc., P. O. Box 190, Hampton, VA 23669, dropped off at:1320 LaSalle Avenue, Hampton or Faxed to:  757-723-0649

 




Your Email (required)

First Name (required)

Last Name (required)

Address (required)

City (required)

State (required)

Zip Code (required)

Home Phone (required)

Cell Phone (required)

Work Phone

First Time H.E.L.P. Volunteer? (required)

Describe EMPLOYMENT Information: (required)

Describe VOLUNTEER Experience: (required)

WHAT TYPE OF WORK ARE YOU INTERESTED IN: (required)

Areas of Work:
NewsletterOfficePharmacist (Licensed)Dental AssistantFundraisingScreeningPhysician (Licensed)HygienistSpecial EventsNursingDentist (Licensed)Other

Times Available to Volunteer
Monday MorningMonday NoonMonday AfternoonTuesday MorningTuesday NoonTuesday AfternoonWednesday MorningWednesday NoonWednesday AfternoonThursday MorningThursday NoonThursday Afternoon

Your Message

Confidentiality Statement In assuming my responsibilities as a volunteer of H.E.L.P., I hereby agree to treat as confidential the identity and all information about every person who comes to H.E.L.P. This includes all medical, social services, legal and other records. I further agree to exercise great care in protecting H.E.L.P. records and clients from any unauthorized scrutiny. I understand that any breach of the above agreement may be basis for immediate termination of my association with H.E.L.P.

I acknowledge that by providing my telephone number, email address,
and submitting this form, I may be contacted by telephone and email

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