First Name*

Last Name*

Address:*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

E-mail:*

Phone:*

Area Code

 – 

Phone Number

Occupation:*

Under 18?:*

Yes

No

Are you a member of a church?*

Yes

No

Name of Church:

Select value1st Harmony Worship CenterBeechridge BaptistBuffalo Lick BaptistBurks Branch BaptistCentenary United MethodistChurch of the AnnunciationClay Street BaptistChrist CommunityDover BaptistElmburg BaptistEmmanuel BaptistFirst Christian ShelbyvilleFirst Presbyterian ShelbyvilleGraefenburg BaptistHighland Baptist ShelbyvilleHighland Baptist LouisvilleHoly Cross LutheranIndian Fork BaptistLiving WatersNew HopeNew Mount Zion Baptist Olive Branch United MethodistRhema ChristianSalem BaptistShelby ChristianShelbyville Christian AssemblyShelbyville First BaptistShelbyville WesleyanSimpsonville BaptistSoutheast ChristianSt. John United MethodistVictory BaptistOther (Type in below)

Other Name of Church

Denomination

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Available to Stay to help clean up?

Yes

No

First Choice*

Select valueAnywhere NeededDental TeamEvangelism TeamExit DeskGatekeeperVolunteer RegistrationGuest RegistrationGuest ShepherdKitchen TeamPrayer TeamParking TeamSpa TeamTransportation TeamVision TeamMedical Team Food Pantry

Second Choice*

Select valueAnywhere NeededDental TeamEvangelism TeamExit DeskGatekeeperVolunteer RegistrationGuest RegistrationGuest ShepherdKitchen TeamPrayer TeamParking TeamSpa TeamTransportation TeamVision TeamMedical TeamFood Pantry

Translator

Yes

No

Comments

Word Verification

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The clinic will be open from 10am-2pm

While online volunteer registration is currently closed, we still need volunteers. Guest Shepherds are our greatest need. Please come to Shelbyville First Baptist Church anytime after 7am to the Volunteer Registration Desk.

Please come anytime after 7am to

Shelbyville First Baptist Church

1516 Midland Trail

Shelbyville, KY 40065