Apply For Membership - Child Health Association of Sewickley

Hey there, we’re so glad you are interested in becoming a member of Child Health Association!

Complete the application form below and one of our dedicated volunteers will be in touch.

Member Application

Your Information

Please complete and proceed to the question and answer section of your application.

First Name

Last Name

Spouse's Name

Spouse's employer

Spouse/emergency contact phone

Spouse/emergency contact Email

Children's Names and Ages

Home Phone

Your Cell Phone

Your date of birth

Name for mailings (if different from name provided)

CHA Sponsor's Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Ready to continue?

Let's Proceed to the Q & A Section

Question & Answer Section

Please be as thorough as you can with your answers.

Why do you want to be a member of Child Health?

Please list PAST volunteer work.

Please list CURRENT volunteer work.

Are you currently employed? Full-Time/Part-Time? Where?

What is your previous employment/education/training?

What are your special interests or talents?

If there is anything else you would like us to know about you, please tell us!

I have received and understand the Membership Requirements pertaining to (1) New Member Orientation, (2) Meeting Attendance, (3) Volunteer Service Responsibilities and (4) Financial Responsibilities, and have discussed any questions with my CHA Sponsor (or a CHA Board Member).

Hey there, we’re so glad you are interested in becoming a member of Child Health Association!

Complete the application form below and one of our dedicated volunteers will be in touch.

Your Information

Question & Answer Section

When we care for our children, we build our community.

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