Create Volunteer Profile

Welcome to the Springfield Rescue Mission Community Event Registration & Volunteer page. Thank you for your desire to serve as part of the SRM team. Please complete the information requested below to submit your application for review. Opting to inform us of pertinent health issues is helpful to us should an emergency health situation arise. This information is strictly confidential for staff use only. You can return to your profile to update or change this information at any time.

* Indicates a required field
Volunteer Last Name:*
Volunteer First Name:*
Volunteer Primary Phone:*
Volunteer E-mail:*
Confirm E-mail:*
Volunteer Password:*
Confirm Password:*
Volunteer Alternate Phone:
Volunteer Address:*
Volunteer Address Line 2:
Volunteer City/Town:*
Volunteer State:*
Volunteer Zip Code:*
Emergency Contact Name:*
Emergency Contact Phone:*
Serious Medical: heart problems, diabetes,epilepsy,stroke,asthma, etc or physical limitations.:* (1000 character max)
What church do you attend? (optional):
Do you need to fulfill court-ordered community service? If yes, please explain.:* (1000 character max)
Place of Employment:* (1000 character max)
Please provide 3 references with phone numbers and/or email. No Relatives/ significant others!:* (1000 character max)
Have you ever been arrested/convicted of a misdemeanor or felony? If yes, please explain.:* (1000 character max)
Volunteer Birth Date:*
Volunteer Age Group:*
Volunteer T-Shirt Size:*
Volunteer Gender:*
Are you interested in being an event team leader?:*
Upload Volunteer Profile Photo:
Choose Image

(.jpg or .jpeg format only and less than 5MB in size.)
Volunteer Skills:
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