Get Involved

Name*

First Last

Email*

Phone*

(###)###-####

Current Occupation/Employer

Date of Birth

Address*

Street Address Address Line 2 City State ZIP Code

How did you hear about The Lily Pad Cafe?

Do you have experience as a volunteer and/or working with adults with disabilities? If yes, describe below..*

Do you have any physical limitations? If yes, please describe.*

Do you hold any CPR or First Aid certifications?

Availability*

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Mondays
Tuesdays
Wednesdays
Thursdays
Fridays

I would like to volunteer at*

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Lily Pad Cafe Training Mentor
Lily Pad Cafe Intern Job Coach
Lily Pad Cafe Job Placement
Lily Pad Special Events

Please list two references with name, relationship to you, email address, and phone number.*

Please list your emergency contact's name and phone number*

Additional Info

Waiver and Release

As a volunteer of The Lily Pad Foundation. I agree to act as a representative of the organization. In doing so, I understand that I am a reflection of the The Lily Pad Foundation. mission and brand. I agree to conduct myself within the mission and principles of the The Lily Pad Foundation organization while performing my volunteer responsibilities. I understand that I will be volunteering at my own risk and that The Lily Pad Foundation, its board of directors, or its employees cannot assume any liability for any accident, injury, or health problem which may arise from any volunteer work I perform. I agree that all of the work I do is on a volunteer basis and that I am not eligible to receive any compensation.

Waiver and Release Consent:*

Check this box to certify that you have read the waiver above & understand its content.

Join the Lily Pad Family

Job Coaching | Events | Fundraising

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Become a Lily Pad Volunteer

Additional Info

Waiver and Release