Thank you for your interest in volunteering at Gilda’s Club Quad Cities! Please fill out the following application to begin the process of joining our volunteer team. 

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General Volunteer Information

Location of Form Completion Select... Gilda's Club Moline Gilda's Club Davenport Gilda's Club Clinton Iowa Health Care Outreach Virtual Clubhouse Not Listed Are you a high school or college student? YesNo If yes, what school do you attend? If < 18, name of parent/guardian you reside with Employer What is your personal experience with cancer? Select... Self Other None Credentials or Licensure Special Skills, Certifications or Qualifications Loading… CPR/First Aid Babysitter Training Data Entry Foreign Languages/Translation Graphic Design Art Music Event Planning Writing Health/Fitness Instructor Close Other Skills Volunteer roles of interest Loading… Gilda's Goodie Gang Children and Teen Program Team Member Social Event Volunteer Hospital Outreach Community Outreach Workshop/Lecture Volunteer Gilda's Greeters Administrative Support Via Technology Administrative Support (no technology) As-Needed Development/Fundrasing Volunteer Event Committee Volunteer Close Interested in leading a workshop/lecture/program? YesNo Professional area of expertise 0/1000 characters Limitations, physical or otherwise? YesNo Special consideration details 0/1000 characters

How did you hear about volunteering with us? Loading… Community Event School Friend/Family Cancer Support Community Staff/Volunteer Newspaper TV/Radio Internet Social Media Not Listed Close

Marital Status Select... Single Married Widowed Divorced Separated Living with significant other Domestic partnership Not Listed Sexual Orientation Select... Straight Bisexual Gay Lesbian Queer Not Listed Race/Ethnicity Select... White (Non-Hispanic) African-American (not Hispanic) White-Hispanic Black-Hispanic Asian/Pacific Islander American Indian/Alaska Native/First Nations Not Listed Are you active military or a veteran? YesNo

Emergency Contact Information

Emergency Contact Name Relationship to you Select... Child(ren) Doctor Office Friend Parent/Guardian Religious Official Sibling Significant Other Spouse/Partner Other Family Member Other Home Phone Cell Phone Work Phone

Background Information

Ever convicted of a crime? YesNo Ever been charged with child abuse/neglect? YesNo

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