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Volunteer Recruitment Form
Thank you for your interest in volunteering for Interlakes Community Caregivers!
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References

List names, addresses, and telephone numbers of two adults (not members of your family) that we may contact for personal character references:

Emergency Contact

In the event of an emergency, please let us know whom we should notify.

Acknowledgement

In completing this application, I agree that all information is correct to the best of my knowledge and understand that ICCI will maintain confidentiality as to any information shared on this application.
Use your mouse (or touch screen) to create a digital representation of your actual signature.