Thank you for your interest in volunteering at Gilda’s Club Kentuckiana! Please fill out the following application to begin the process of joining our volunteer team. Personal Information First Name * Mr. Mrs. Ms. Miss Prof. Dr. Rev. Master Last Name * Suffix Preferred Name Home Address * City * State * Zip * Country * United States Canada Australia New Zealand ------------------------- Afghanistan Albania Algeria Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Belarus Belgium Benin Bermuda Bhutan Bolivia Bosnia-Herzegovina Botswana Brazil British Honduras (Belize) British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Island (Australia) Colombia Comoros Congo (Brazzaville),Republic of the Congo, Democratic Republic of the Cook Islands (New Zealand) Costa Rica Cote d'Ivoire (Ivory Coast) Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (Indonesia) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French West Indies (Guadeloupe or Martinique) Gabon Gambia Georgia, Republic of Germany Ghana Gibraltar Great Britain and Northern Ireland Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, Republic of Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte (France) Mexico Moldova Monaco (France) Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia Nicaragua Niger Nigeria Niue (New Zealand) Norfolk Island (Australia) North Korea Norway Oman Pakistan Panama Papua New Guinea Paraguay Persia (Iran) Peru Philippines Pitcairn Island Poland Qatar Reunion Romania Russia Rwanda Saint Helena Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia-Montenegro Seychelles Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa South Georgia (Falkland Islands) South Korea Spain Sri Lanka St. Christopher and Nevis Sudan Suriname Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Tokelau (Union) Group (Western Samoa) Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis and Futuna Islands Western Samoa Yemen Zambia Zimbabwe Email * Home Phone Work Phone Cell Phone* I agree to receive text messages at this number. Date of Birth * Loading… December 2023 SunMonTueWedThuFriSat 48262728293012 493456789 5010111213141516 5117181920212223 5224252627282930 0131123456 TodayClear JanFebMarApr MayJunJulAug SepOctNovDec OKCancel Gender Other Woman Man Nonbinary Transwoman Transman N/A {{$t('contact.address.verification.multiple-Title')}} General Volunteer Information Race/Ethnicity* Select… Am. Indian - Alaska Native - First Nation Asian/Pacific Islander Black Black Hispanic Hispanic Hispanic-White AA Caucasian Other White not Hispanic Place of Employment or School Credentials or Licensure Spanish/Translation Special Skills, Certifications or Qualifications Loading… Select… CPR/First Aid Babysitter Training Graphic Design Art Music Event Planning Writing Health/Fitness Instructor Close Other Skills Interested in leading a workshop/lecture/program?* YesNo Professional area of expertise: 0/1000 characters Limitations, physical or otherwise:* YesNo Special consideration details: 0/1000 characters Personal experiences with cancer? * Select… Self Other None How did you hear about volunteering with GC?* Select… Social Media School/Teacher Current Gilda’s Volunteer/Staff Member Friend/Family Member Workplace Radio/TV/Newspaper Community Event Referral Community Event Name Referral Other Emergency Contact Information Name* Relationship* Select… Spouse/Partner Parent Child Sibling Grandparent Grandchild Aunt/Uncle Friend Primary Phone* Alternate Phone Background Information Ever convicted of a crime? * YesNo Ever charged with child abuse or neglect? * YesNo Portal OptionsVolunteer Registration