Today's Date *

MM

DD

YYYY

Name *

First Name

Last Name

Date of Birth *

Must be between 11 & 22 years old.

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone

(###)

###

####

Other Phone

(###)

###

####

Let us know which group you are interested in helping with: *

North Bend

Kenmore

Auburn

Covington

Renton

Federal Way

Skyway

White Center

Woodinville

Person to be notified in case of an emergency *

First Name

Last Name

Their cell phone number. *

(###)

###

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Required Signature: I certify that all information submitted in this application is factually true, complete, and honestly presented. I authorize Lambert House to review my application, to research the information on this form, and to conduct background checks on me. I understand that I may be subject to a range of possible disciplinary actions, including termination as a volunteer, should the information I’ve certified be false either through omission or commission. *

By printing your name below and clicking "Submit," you agree to the above statement.

First Name

Last Name