Volunteer Application 
                        
                        
                            
                            Highlight your primary volunteer location* 
                            
                            
                                -- Choose One -- 
                                                                    
                                                                                    Aitkin, MN
                                                                             
                                                                    
                                                                                    Albert Lea, MN
                                                                             
                                                                    
                                                                                    Alexandria, MN
                                                                             
                                                                    
                                                                                    Amery, WI
                                                                             
                                                                    
                                                                                    Apple Valley, MN
                                                                             
                                                                    
                                                                                    Appleton, WI
                                                                             
                                                                    
                                                                                    Arden Hills, MN
                                                                             
                                                                    
                                                                                    Ashland, WI
                                                                             
                                                                    
                                                                                    Askov, MN
                                                                             
                                                                    
                                                                                    Austin, MN
                                                                             
                                                                    
                                                                                    Baudette, MN
                                                                             
                                                                    
                                                                                    Bemidji, MN
                                                                             
                                                                    
                                                                                    Bloomington, MN
                                                                             
                                                                    
                                                                                    Brainerd, MN
                                                                             
                                                                    
                                                                                    Butternut, WI
                                                                             
                                                                    
                                                                                    Cameron, WI
                                                                             
                                                                    
                                                                                    Chippewa Falls, WI
                                                                             
                                                                    
                                                                                    Clintonville, WI
                                                                             
                                                                    
                                                                                    Cook, MN
                                                                             
                                                                    
                                                                                    Cromwell, MN
                                                                             
                                                                    
                                                                                    Cumberland, WI
                                                                             
                                                                    
                                                                                    Dawson, MN
                                                                             
                                                                    
                                                                                    Denmark, WI
                                                                             
                                                                    
                                                                                    Dodgeville, WI
                                                                             
                                                                    
                                                                                    Duluth, MN
                                                                             
                                                                    
                                                                                    East Chain, MN
                                                                             
                                                                    
                                                                                    Eau Claire, WI
                                                                             
                                                                    
                                                                                    Eden Prairie, MN
                                                                             
                                                                    
                                                                                    Ellsworth, WI
                                                                             
                                                                    
                                                                                    Eveleth, MN
                                                                             
                                                                    
                                                                                    Fargo, ND
                                                                             
                                                                    
                                                                                    Fergus Falls, MN
                                                                             
                                                                    
                                                                                    Foley, MN
                                                                             
                                                                    
                                                                                    Fond du Lac, WI
                                                                             
                                                                    
                                                                                    Forest Lake, MN
                                                                             
                                                                    
                                                                                    Gillett, WI
                                                                             
                                                                    
                                                                                    Grand Marais, MN
                                                                             
                                                                    
                                                                                    Grand Rapids, MN
                                                                             
                                                                    
                                                                                    Green Bay, WI-Central
                                                                             
                                                                    
                                                                                    Greenville, WI
                                                                             
                                                                    
                                                                                    Hartford, WI
                                                                             
                                                                    
                                                                                    Hayward, WI
                                                                             
                                                                    
                                                                                    Hermantown, MN
                                                                             
                                                                    
                                                                                    International Falls, MN
                                                                             
                                                                    
                                                                                    Isanti, MN
                                                                             
                                                                    
                                                                                    Jefferson, WI
                                                                             
                                                                    
                                                                                    Lebanon, WI
                                                                             
                                                                    
                                                                                    Little Falls, MN
                                                                             
                                                                    
                                                                                    Marshfield, WI
                                                                             
                                                                    
                                                                                    Mason City, IA
                                                                             
                                                                    
                                                                                    Medford, WI
                                                                             
                                                                    
                                                                                    Menahga, MN
                                                                             
                                                                    
                                                                                    Mondovi, WI
                                                                             
                                                                    
                                                                                    Montello, WI
                                                                             
                                                                    
                                                                                    Moorhead, MN
                                                                             
                                                                    
                                                                                    Mt. Horeb, WI
                                                                             
                                                                    
                                                                                    New Richmond, WI
                                                                             
                                                                    
                                                                                    North Branch, MN
                                                                             
                                                                    
                                                                                    Onalaska, WI
                                                                             
                                                                    
                                                                                    Oshkosh, WI
                                                                             
                                                                    
                                                                                    Osseo, WI
                                                                             
                                                                    
                                                                                    Perham, MN
                                                                             
                                                                    
                                                                                    Peshtigo, WI
                                                                             
                                                                    
                                                                                    Platteville, WI
                                                                             
                                                                    
                                                                                    Prairie du Chien, WI
                                                                             
                                                                    
                                                                                    Ramsey, MN
                                                                             
                                                                    
                                                                                    Redwood Falls, MN
                                                                             
                                                                    
                                                                                    Rhinelander, WI
                                                                             
                                                                    
                                                                                    Rochester, MN
                                                                             
                                                                    
                                                                                    Roseau, MN
                                                                             
                                                                    
                                                                                    Sauk Centre, MN
                                                                             
                                                                    
                                                                                    Sheboygan, WI
                                                                             
                                                                    
                                                                                    Sherburn, MN
                                                                             
                                                                    
                                                                                    Silver Bay, MN
                                                                             
                                                                    
                                                                                    Spooner, WI
                                                                             
                                                                    
                                                                                    St. Charles, MN
                                                                             
                                                                    
                                                                                    Staples, MN
                                                                             
                                                                    
                                                                                    Tomah, WI
                                                                             
                                                                    
                                                                                    Waupaca, WI
                                                                             
                                                                    
                                                                                    Wausau, WI - New Hope
                                                                             
                                                                    
                                                                                    West Bend, WI
                                                                             
                                                                    
                                                                                    Wisconsin Rapids, WI
                                                                             
                                                                    
                                                                                    Zumbrota, MN
                                                                             
                                
                                                                    
                                                                                    Ruby’s Retreat Center - Luck, WI
                                                                             
                                                                    
                                                                                    Ruby’s Well Care Center - Luck, WI
                                                                             
                                                                    
                                                                                    Ruby’s Hair Salon - Luck, WI
                                                                             
                                                             
                        
                        
                         
                        
                        
                            First Name* 
                             
                                                    
                        
                            Middle Name* 
                             
                                                    
                        
                            Last Name* 
                             
                                                    
                        
                            Former Last name(s) 
                             
                                                    
                        
                            Street Address* 
                             
                                                    
                        
                            City* 
                             
                                                    
                        
                            Country 
                            
                                Select Country 
                                                                    Canada 
                                                                    United States 
                                                             
                                                    
                        
                        
                            Zip Code* 
                             
                                                    
                        
                            Email* 
                             
                                                    
                        
                            Primary Phone* 
                             
                                                    
                        
                            Date Of Birth* 
                             
                        
                        
                        
                            
Emergency Contact 
                        
                        
                            First & Last Name* 
                             
                        
                        
                            Relationship* 
                            
                            
                                -- Select Relationship 
                                                                    Friend 
                                                                    Family 
                                                                    Father 
                                                                    Mother 
                                                                    Parent 
                                                                    Guardian 
                                                                    Son 
                                                                    Daughter 
                                                                    Child 
                                                                    Aunt 
                                                                    Uncle 
                                                                    Husband 
                                                                    Wife 
                                                                    Partner 
                                                                    Cousin 
                                                                    Grandmother 
                                                                    Grandfather 
                                                                    Grandparent 
                                                                    Grandson 
                                                                    Granddaughter 
                                                                    Grandchild 
                                                                    Employer 
                                                                    Employee 
                                                                    Coworker 
                                                             
                        
                        
                            Phone Number 
                             
                        
                        
                            
Experience & Restriction 
                        
                        
                            Experience / Skill 
                            
                        
                        
                            Medical / Physical Restriction 
                            
                        
                        
                            
Background 
                        
                        
                        
                            If yes, please explain: 
                            
                            *Felony conviction does NOT automatically exclude you from
                                participation 
                        
                        
                        
                        
                            If court ordered, please provide nature of the offense: 
                             
                        
                        
                            Hours Required 
                             
                        
                        
                            
Group Information 
                        
                        
                        
                            Group Name 
                             
                        
                        
                            Main Contact Person for Group 
                             
                        
                        
                        
                            I agree and WILL NOT hold Ruby’s Heart/Ruby’s Pantry, or their agents or representatives
                                liable for injury or other damages incurred as a result of the job duties given to me as a
                                volunteer. Though thoughtfully assigned, I understand that the final judgment of physical
                                limitations per assignment is solely my responsibility. All food and/or items used for
                                distribution are for donation purposes and/or the property of Ruby’s Pantry and Pop-Up
                                Pantry site.
                            I grant full permission for Ruby’s Heart/Ruby’s Pantry to use any photographs, film, video or
                                audiotapes of me performing volunteer work for any purpose Ruby’s Heart deems appropriate.
                            
                         
                        
                        
                        
                            Parent or guardian full name*: 
                             
                        
                        
                            Relationship to applicant*: