Volunteer Form

If you are interested in volunteering, please fill out and submit the form below and then read our Volunteer Preparation page. (Do not email your information if you are concerned about confidential information. Fill the form out and do not submit it, but print it and mail it to the address here). We are so excited that you are interested in serving with our team. We welcome individuals as well as groups. Feel free to email melodie@journeyofajoyfullife.org with any questions.

Click here to view our Volunteer Preparation page.

First Name:
Last Name:
E-mail Address:
Home Phone Number:
Work Phone Number:
Cell Phone Number:
Address:
City:
State:
Zip Code:
Date of Birth:
Place of Birth (City, State or Province, Country):
Occupation:
Emergency contact: E-mail & Phone # :
Beneficiary:
Beneficiary Relationship:
Passport Number:
Country of Insurance:
Do you have any specific talents you wish to bring to the team? (Specify):
Do you have prior mission experience? (Specify):

The following questions are asked to help us to be prepared for potential health problems should they arise during the trip. This information is treated as confidential and with respect for participant's privacy.

Have you had any of the following problems with or been told by a physician you had (check all that apply):

Epilepsy
High Blood Pressure
Hepatitis or Liver Disease
Pregnancy
Anemia
Cancer-Leukemia or Lymphoma
Kidney Disease
Scarlet Rheumatic Fever
Heart Attack Failure or Murmurs
AIDS-HIV
Bowel Disease Ulcers or Colitis
Diabetes
Bleeding Problems
Alcohol or Drug Abuse
Known Disability
  Asthma or Chronic wheezing
Cysts or Tumors of any kind
Chronic or persistent cough
Skin Disorder
Goiter
Circulatory Problems
Hearing or Vision Impairment
Rheumatism Arthritis Painful swollen joints
Severe Knee Problems
Mental Health Counseling treatment
Fainting Spells
Parkinson's disease
Thyroid ailment
Severe Allergic Reactions

Do you take any Medications?: Yes No
If so What?:
Are you allergic to any medications?: Yes No
If so What?:
Comments:
Are you human: Yes!