Volunteer Application

Martial Status *

Number of Children *

Name of Spouse *

Age(s) *

Have you ever been convicted of a crime? *

Yes No

List any previous volenteer experience *

May we contact previous volunteer agencies? *

Yes No

Do you consider yourself a Christian? *

Yes No

If Yes, explain *

Please provide the following information about your church:

Church Name: *

Church Phone Number *

Senior Pastor's Name *

Church Address *

Church Zip Code *

How long have you been involved at the church? *

Do you have any experience in the following areas? Unplanned pregnancy, adoption, abortion or counseling - If yes, please explain: *

How do you feel about the use of birth control (pills, devices, and condoms) by unmarried girls/women? *

Please list two references other than your pastor or family members that we may contact: *

Thank you so much for completing this application. Please return this to our office and we will contact
you to set up an interview. God is at work at Heartbeat Hope Medical and we look forward to sharing His
joy with you.

Heartbeat Hope Medical
Fremont Center
300 S. Front St.
Fremont, OH 43420
419-334-9079

Tiffin Center
380 W. Market St.
Tiffin, Ohio 44883

Fostoria Center
513 Plaza Dr.
Fostoria, Ohio 44830

Online Application

Please provide the following information about your church:

Volunteer Application