Refugee Outreach Program
Adult Registration

Thank you for your interest in serving as a Adult Volunteer with St. Patrick Refugee Outreach Program.

Title:    First Name *    Last Name *    Nickname

Home address *     City *   ZIP *

At least one phone number is required.
Home Phone     Cell Phone

Date of birth * (mm/dd/yyyy)

If you do not have an email address, enter NONE.
Email Address *
Confirm your email address *

Frequency of attendance * Adults that can attend regularly will be assigned to classrooms.

Volunteer Preference * How would you like to help?

Safe Environment * Please indicate your understanding of Safe Environment requirements by checking all boxes.
I understand that when I submit this registration form, I will be notified of whether I have completed my Adult Screening and am therefore immediately eligible to serve.
I understand if I am not already cleared, I must meet the Adult Safe Environment Screening requirements before I am eligible to serve.
I understand the Forms and Instructions for being screened are on the St. Patrick Church website.
I understand that once I complete the Adult Screening requirements, my adult clearance is valid until the last day of the month that is 12 months from the date of my last training.