Potter's Clay Fellowship

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Gender *

Male

Female

Best Number to Contact

(###)

###

####

Preferred Contact Method

Email

Phone

T-Shirt Size

We only ask so we can keep your size on hand when we order shirts. As a volunteer you may receive a t-shirt. Whoo hoo!

Small

Medium

Large

XL

XXL

XXXL

Name of Reference *

First Name

Last Name

Best Number to Contact *

(###)

###

####

Have you ever been accused of, convicted, or pleaded guilty/no contest to any criminal offense or sexual misconduct? *

Yes

No

I agree too, and hereby authorize Potter's Clay Fellowship to conduct a background check that may include: Criminal and Public records, and Personal References. *

Yes

No

I give Potter's Clay Fellowship permission to use any photos and videos with my likeness, obtained while volunteering to be used for marketing, promotional and or social networking purposes for Potter's Clay Fellowship. *

Not limited to photos and videos.

Yes

No