Homebound Volunteer Form
OUR PRIMARY PURPOSE IS TO HELP ANOTHER ALCOHOLIC TO ACHIEVE SOBRIETY

Thank you for volunteering to be of service with Homebound. The following questionaire will be used to help us to align you with service requests available in your area. If you have questions or concerns, please contact us at homebound.chair@gmail.com.

THANK YOU FOR YOUR SERVICE
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First Name *
Last Initial *
Phone Number
Email Address
Do you relate as an Alcoholic? (This service is provided by Alcoholics Anonymous)
Clear selection
Day(s) of the week you are available *
Required
Time(s) you are available *
Gender
What city do you live in?
What city are you available for service?                                                                                                                                                            This is a service provided by the Valley Service Center Intergroup. We support the service needs in Dublin, Livermore, Pleasanton and Sunol areas. *
Required
Sobriety Length.                                                                                                                                                                                      (There is no sobriety requirement to volunteer for Homebound except to Secretary a meeting (9 mths) *
Do you have a sponsor?
Homegroup (name, day, time)
Have you worked (or are currently working) the steps? *
Service interest.                                                                                                                                                                                                                                     (What areas of Homebound are you looking to be of service?) *
Required
Do you have allergies? *
Required
Have you Been Covid Vaccinated? *
Additional Comments
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