First Name * Required Last Name * Required Email * Required Please choose a login password * Required Address City State Zip Home Phone Cell Phone Gender Select Value Male Female N/A * RequiredBirth Date mm/dd/year * Required Race Select Value American Indian/Alaskan & Black Asian Black/African American Black/African American & Hispanic Black/African American & White Hawaiian/Pacific Islander Hispanic White Non Hispanic Other Multiple Race/Hispanic Other Multiple Race/Non Hispanic Prefer not to respond Please check all languages spoken. If other, specify in the box provided:English Creole Spanish Other Language spoken Veteran? Select Value Yes No NA Area of Residence Select Value Allapattah Brownsville Buena Vista West Liberty City Other Broward County neighborhood Other Miami-Dade County neighborhood Wynwood Other * RequiredT-Shirt size Select Value Children Small Medium Large XL XXL Meal Option Preference Select Value Gluten-Free Vegetarian Vegan Nut Allergy No Preference Group affiliation? Select Value None Faith Based Corporate School Government Civic Other * RequiredRole in the group? Select Value Group Leader / Main Contact Participant N/A * RequiredGroup name Please tell us about any access or mobility accommodations we can provide. Are you a Student? Select Value Yes No NA What school do you attend? Emergency contact name Emergency contact phone # Preferred volunteer role Select Value General Volunteer Volunteer Leader Both Please indicate if you must fulfill any required Volunteer service obligation.Volunteer Hours Required? Select Value Yes No NA How did you hear about NHSSF? Select Value --SELECT ONE-- Board Member Campaign - LIFT Church Collaborative Entity Idealist.org Website Import Internet Search Lender Mailing Media Media - Newspaper/TV/Radio NHSSF Event Paint Day 2012 Paint Day Broward Paint Day Miami Partner Agency Personal Friend Referral School Select Value Staff Staff NHS Staff Research Unknown VolunteerMatch Web Site * RequiredPlease click here to review our Hold Harmless Agreement. You must consent to the conditions of this agreement in order to volunteer for us.Do you agree to the Hold Harmless Agreement? Select Value I Agree * RequiredAgreement Date (TODAY'S Date) * Required This is Step 1 of 3. Please enter the numbers presented in the photo below and then click SAVE for the NEXT STEP in your registration! Please leave this checkbox blank
