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
Are you a high school or college student?
If yes, what school do you attend?
If < 18, name of parent/guardian you reside with
Employer
What is your personal experience with cancer?
Credentials or Licensure
Special Skills, Certifications or Qualifications
v
Other Skills
Volunteer roles of interest
v
Interested in leading a workshop/lecture/program?
Professional area of expertise
0/1000 characters
Limitations, physical or otherwise?
Special consideration details
0/1000 characters
How did you hear about volunteering with us?
v
Marital Status
Sexual Orientation
Race/Ethnicity
Are you active military or a veteran?

Emergency Contact Information
Contact Name
Relationship to you
Home Phone
Cell Phone
Work Phone

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