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Dle) (Last) Address (Street) (City) Home Telephone Race (State) (Zip) Other Telephone Date of Birth E-mail VOLUNTEER POSITION DESIRED: AVAILABILITY AND LENGTH OF COMMITMENT: Please check the days you are available and indicate times behind each. Monday Tuesday Friday Thursday Sunday Wednesday Saturday How long can you commit to this volunteer service? When are you available to start? MEDICAL AND CRIMINAL HISTORY: Please respond to the following questions.

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