Name

First Name

Last Name

Gender

Male

Female

Birthdate

MM

DD

YYYY

Email

What experience do you have in working with kids with special needs?

Why do you want to serve in this area?

Have you served in any other areas at Living Word?

Have you completed Steps 1-4 of Life Track?

Yes

No

How often a month would you be interested in serving:

If you have additional questions please contact our Haven Director, Ashlyn Eldridge, at ashlyn@dlwc.org.