Become a Volunteer Contact Info Background Affiliation Responses Availability & Interests Finalize Company Contact Information Title * Choose One Mr. Ms. Mrs. Prof. Dr. First Name * Last Name * Email Address * Main Number * Other Phone Address Line 1 * Address Line 2 City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== 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 Zip Code * Next Page Background Place of Employment * Spouse's Name Names / Ages of Children How did you learn about Crossroads Clinic? Church Friend Volunteer / Staff Website Online Search Radio Other please check all that apply Other Previous Page Next Page Affiliation Church Name * Pastor or Ministry Leader's Name * Please link to church website Why do you want to be a volunteer for Crossroads Clinic? * Do you consider yourself a Christian? * Yes No Undecided If you checked undecided, please explain What does being a Christian mean to you? * Previous Page Next Page Your Responses Have you ever experienced an unplanned pregnancy? * Yes No If yes, please explain How do you feel about abortion as a solution to an unplanned pregnancy? * Have you ever experienced an abortion personally? * Yes No If yes, please explain Have you ever been involved with someone (friend, relative, etc.) who has experienced an abortion? * Yes No If yes, please explain How do you feel about adoption as an alternative for a person in an unplanned pregnancy? * How do you feel about an unmarried woman / unmarried couple parenting a baby? * How do you feel about single men and women using birth control? * Please list special skills and background experience * Previous Page Next Page Availability & Interests When are you available to volunteer? * Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Weekend AM Weekend PM please check all that apply What areas are you interested in volunteering? * Pregnancy Center Administration Men's Services Medical Services Other please check all that apply if other, please specify Have you ever been convicted of a felony * Yes No Previous Page Review Summary Review Summary Edit Information Submit
