“MAITRI”

‘KALYAN’, 32, NATRAJ SOCIETY, KARVENAGAR, PUNE 411052. TEL. 25443134, 25450882
E MAIL : maitri1997@gmail.com

Volunteer Form

Name :

Address :

Birth date : Age : Sex : E-mail :

Telephone :
Residence Office Mobile

In case of emergency, indicate the name of person whom we should contact :

Name :

Telephone :
Residence Office Mobile

Educational Qualifications :

Occupation :

Hobbies :

Experience of social work if any :

Are you associated with any other social or political organization? If yes, specify :

Languages :

Duration for which you are willing to volunteer yourself : Days Weeks Months
The period when you can volunteer yourself :

Tick any of the following skills you have :

Trained in First Aid Water Quality Management

Trained Paramedic Environmental Sanitation
Doctor Technician
Administration Communication & writing
Management & Coordination Cooking in community kitchen
Counseling Driving
Handling Computers & Internet Swimming
Trained in Emergency Response

Any other (Please specify) :

I wish to participate in the Dhadak Mohim activity of “MAITRI” with my own free will and I
promise to abide by the rules and instructions given by “MAITRI”. I am also aware of the risks of
working in Dhadak Mohim activity. I am entirely responsible for my own behavior in the field and
for my safety.

Yours sincerely,

(Signature)

For Office use only : (To be filled by concerned person from “MAITRI”)

Selected / Not selected Selected for Batch No.

Batch Period : From To

Training Completed on (Date of Training Completion) :

Signature of The Concerned Person of “MAITRI” : Date :