Serving Hearts Application Step 1 of 4 25% The information you provide on this application enables us to place you in a position that best fits your interests / skills. Thank you for your interest in the program. Date of Application*Name* First Last Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone* How would you like to volunteer?Programs of InterestPlease check all that apply. These areas of interest have been adapted from the Crystal Peaks Youth Ranch website, CPYR.org. Please click here to view explanations. Please note that seasonal or special needs are marked with an asterisk (*). Mentor (Session Instructor) MINT Mentor Greeter / Listener Prayer Team Playpal Housekeeper Photographer Green Thumb Energy Booster / Goody Maker * Power House * Professional Assistance * Teacher * Fund Raiser * Musician * Artisan * Memory Maker * Please note the days of the week that you would be willing to serve. Also include the time that you would be able to arrive and leave on the days you would be volunteering (i.e. Monday: 8am - 1pm).Seasonal / Special Projects Volunteer I would like to be contacted when help is needed on weekends. I would like to help with special projects (ex. Building a shed, fencing, staining/painting, events). I have skills in areas listed in the box below. I could possibly help on short notice (within two days) of a project. I may be contacted about volunteering opportunities beginning on the date specified below. I would like to serve only on the days specified below. My Skill Areas:I would like to volunteer between the below dates.Date I can begin serving:Clarification notes for "Seasonal / Special Projects" Section Tell Us About YourselfWhile the Youth Ranch is not a "religious" organization, our principles and values are Christ centered. We hope everyone that comes to the Ranch will see the love of Christ through us. How do you feel about that?SkillsPlease list any other skills or areas of service that you feel you could contribute to the Breakaway Youth Ranch.What are some values that are important to you? (Ex. Family, Hard Work)What are some unique things about you? Tell us about activities you like to do or be a part of.Would you say you have a relationship with God?Why do you want to be a part of Breakaway Youth Ranch?How did you hear about us? Thank you so much for your interest in BYR!Contact us at: 263 Cottonwood Road Cardwell, MT 59721 (406) 581-5488 (Amanda) www.breakawayyouthranch.org breakaway.y.r@gmail.com Δ
