The Healing Center
The Healing Center
11345 Century Circle W.
Springdale, Ohio 45246
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Address
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Address Line 2
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Phone Number
Phone Number
*
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Email
*
Adult T-Shirt size choice
Adult T-Shirt size choice
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XL
2XL
Do you have friends/family that will be coming with you for this service opportunity? If yes, please let us know who.
Do you have friends/family that will be coming with you for this service opportunity? If yes, please let us know who.
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Last
Additional Guest 1
Additional Guest 1
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Last
Adult T-Shirt size choice
Adult T-Shirt size choice
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M
L
XL
2XL
Additional Guest 2
Additional Guest 2
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Adult T-Shirt choice
Adult T-Shirt choice
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M
L
XL
2XL
Please list an emergency contact
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Phone
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Please list any mobility restrictions, allergies, or other medical conditions that would be important for us to know:
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What do you hope to give and/or get out of this experience?
By selecting the "yes" checkbox and typing your name in the box below, you are electronically signing the
Volunteer and Waiver Form.
*
By selecting the "yes" checkbox and typing your name in the box below, you are electronically signing the
Volunteer and Waiver Form.
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Please sign your first and last name
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How did you hear about this opportunity
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