Registration

Volunteer Start Date First Name: Last Name: Address: Address Line 2 City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip: - Zip Suffix Homeless? Cashiers Client? Phone: Agree to accept texts? Yes No Evening Phone: Email: Church Affiliation Language spoken at home How did you hear about UCM? Gender: Female Male Prefer not to say Birth Date(MM/DD/YYYY): / / Veteran? Yes No Active Duty Reserve Race White or Caucasian Hispanic/Latino/Spanish Origin American Indian or Alaska Native Native Hawaiian or other Pacific Islander Asian Black or African American Multiracial Other Enrolled member EBCI? Are you employed? If you are a student, name of school: Income 0-10,000 10,001-15,000 15,001-20,000 20,001-25,000 25,001-30,000 30,001-35,000 35,001-40,000 40,001-45,000 45,001-50,000 Total number in family Other Adult name and DOB: Other Adult Date of Birth Other Adult Names: Total number of children in family Child 1 DOB: Child 2 DOB: Child 3 DOB: Child 4 DOB: Child 5 DOB: Disabled? Yes No Special Dietary needs (choose all that apply) Food allergies Special dietary needs Captcha