Cold Night Shelter Sign-Up Form

Instructions:  Fill in the form below and click "Send."  Your information will be forwarded to the shelter manager, who will then add you to the e-mail list.  After that point, you will receive e-mail alerts for when the shelter will be open and a list of volunteer needs.  If you have any questions, contact Pastor Jonathan at jculley@covenantpalmbay.org.

Remember that if you're unable to help on a particular night, there is no assumed commitment on your part.  But if you can help on that night, just reply to the e-mail alert letting the shelter manager know what shift you want.

Name:
E-mail Address:
Address:
City:
Zip:

Home Phone:
Cell Phone:
Work Phone:
Best time of day to call:

Church or Ministry Affiliation:

Available Shifts. Check the hours you are interested in working at the shelter (** = especially needed).
7:00pm to 10:00pm
7:00pm to Midnight
10:00pm to Midnight
Midnight to 4:00am **
4:00am to 6:00am **
4:00am to 8:00am **
6:00am to 8:00am

Available Nights. Check the nights you might be available to work.
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Frequency. Maximum number of times per month you might be able to volunteer (approximately):
1-2 times
2-4 times
4-6 times
6-8 times
8+ times
Any amount

Other Needs. Check any of the following that you are interested in helping with:
Blanket delivery to and from Holmes Regional Hospital
Prepare fresh soups for frozen soup bank
Help with mailings, delivering flyers, making posters, etc.
Help with telephone calls/volunteer coordination
Donate: coffee, sugar, creamer, hot chocolate, juices, etc.
Donate: socks (large men's tube socks) and gloves
Help with pick up and drop off of supplies
Financial donations for supplies (payable to His Place Ministries; Memo: Cold Night Shelter; PO Box 034068, Indialantic, FL, 32903)

Other Skills / Gifts / Talents / Interests:

Comments / Questions / Suggestions: