I AM DOM – Volunteer Application

Thank you for your interest in volunteering for I AM DOM Foundation events. Our volunteers will assist at various fundraising events for our foundation. If you support our mission to assist families with children suffering from cancer, then we encourage you to complete this application. The information you provide will be kept confidential and will assist us in matching you with a satisfying volunteer opportunity. Please submit the following form and an I AM DOM board member will contact you.
For any questions, please contact our Volunteer Chair, Yvette Palacio: 913-544-8178

* Required

We are proud to announce that the I AM DOM Foundation, is now a registered non-profit organization, under code section 501(c)(3), by virtue of it’s charitable activities and program.

    Gender (required)
    MaleFemale

    Physical limitations(required)
    YesNo

    Education (Highest Level Completed)(required)

    Employer and position (required)

    List volunteer experience (required)

    Skills (required)

    Certifications (required)
    CPRFirst AideOther:

    Are you fluent in Spanish? (required)
    YesNo

    Volunteer Availability: Choose All That Apply (required)

    Do you have transportation (required)

    How did you hear about us (required)

    In case of an emergency, notify: *
    Please provide First name, Last name, Phone number, and Relationship (Spouse, daughter, son, friend, etc.)

    Volunteer Signature and Date

    As a volunteer for I AM DOM Foundation, I agree to abide by the policies and procedures. I understand that I will be volunteering at my own risk and that I AM DOM Foundation, its employees and/or affiliates, cannot assume any responsibility for any liability for any accident, injury, or health problem which may arise from any volunteer work I perform for I AM DOM Foundation. I agree that all the work I do is on a volunteer basis and I am not eligible to receive any monetary payment or reward.

    Please type name below (required)

    I AM DOM

    I AM DOM is named after Dominic Palacio, who we lost on October 20, 2011.   We use his name as a symbol by representing every child with cancer and the families that are going through this life altering time. The struggle not only hits the family’s emotion, physically but also financial. The bills don’t stop coming in just because a child was diagnosed with cancer, childhood cancer is financially devastating. Families going through a tremendous amount of stress who are already dealing with the unimaginable.

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