Volunteer Application Form

1Basic Info

2General Info

3References

4Affirmation & Code of Ethics

5Signature

Name*

First

Last
Are you 18 or older?*
All Chicago Lighthouse volunteers must be 18 or older to participate.
Address*

Street Address

Address Line 2

City

State

ZIP Code
Email*
Phone*
Birth Date

Month

Day

Year
Would you like to be added to our mailing list?*
- Yes
- No

Please list an emergency contact: