New York Disaster Interfaith Services (NYDIS)

Individual Group
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Name * First Last
Gender
Pronouns
Date of Birth * MM / DD / YYYY
Phone Number ### - ### - ####
Email *
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Language(s) Spoken (check all that apply)
English Spanish French Chinese Indic Languages (Hindu, Urdu, Gujarati) Other
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Special Needs/Conditions *
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Volunteer Opportunities (check all that you're interested in)
Clothing Distribution Donation Itemizing Hygiene Kit Assembly Meal Distribution Shelter Site Set-Up
Availability (check all that apply)
Weekdays (9am - 1pm) Weekdays (11am - 3pm) Weekdays (1pm - 5pm) Saturdays (11am - 3pm) Sundays (11am - 3pm)
Emergency Contact First Last
Relationship
Phone Number ### - ### - ####
Photo Release: When you attend a NYDIS Volunteer Opportunity, photography, audio, and video recording may occur. By acknowledging, you consent to such recording media and its release, publication, exhibition, or reproduction to be used for news, webcasts, social media or other promotional outlets. *
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