Women on a Journey – Kitchen Goddess Application

Applicant Information

First Name*

Last Name*

Address*

Address 2

City*

State / Province*

Zip / Postal Code*

Email Address*

Phone*

Alternate Phone

Date of Birth*

Occupation*

Personal Information

Dietary Restrictions*

You will receive a copy of the menu before the Weekend to aid you in decisions around supplementing with your own food. If you have additional dietary restrictions or needs, please be prepared to supply your own food. Refrigerators will be available for your use.

I have NO dietary restrictions.
I am a vegetarian.
I have additional needs and will supplement with my own food.
I will bring ALL of my own foods.

Physical Differences

List any physical limitations that may prevent you from any tasks and duties (bad back, injuries, standing for long periods of time, etc.

Dietary Allergies

Current Medications and Reason for Prescription

CPR Certification Date

First Aid Certification Date

Emergency Contact Information

Emergency Contact Name*

Emergency Contact Number*

Staffing Information

Woman Within Weekend Date (if you have attended the Weekend)*

Approximately how many times have you staffed to help in the kitchen?*

Position Desired

Kitchen Goddess Team*

Kitchen Goddess Lead
Kitchen Goddess Assistant Lead
General Kitchen Goddess

When will you be a Kitchen Goddess?*

Check all of the shifts below you can attend

Whole weekend: Friday 1 pm - Sunday noon
Friday 1pm – Saturday 2pm
Saturday 10:30am – 8pm
Saturday 2pm – Sunday noon

Additional notes about arrival or departure information:

Phone

This field is for validation purposes and should be left unchanged.

Creating Empowering Opportunities For Women

Women On a Journey – Kitchen Goddesses

Applicant Information

Personal Information

Emergency Contact Information

Staffing Information

Position Desired