VOLUNTEER
- Volunteer Information
- Volunteer Application

Volunteer Application

This application is for those wishing to volunteer locally at our Outreach & Wellness Centers and at the Neighborhood House.

Applicant Information

Applicant's Name:	A value is required.Required
Address:	A value is required.Required
City:	A value is required.Required
State	Please select an item.Please select an item.
Zip	A value is required.Invalid format.RequiredInvalid format.
Phone:	A value is required.Invalid format.RequiredInvalid format.
Alternate Phone:	RequiredInvalid format.
Email Address:	A value is required.Invalid format.RequiredInvalid format.
Are you currently employed?	Yes No Please make a selection. Please make a selection.
If yes, where?
Work Phone:	Invalid format.
Have you ever worked as a volunteer before?	Yes No Please make a selection. Please make a selection.
If yes, where?
Are you fluent in any language other than English?	Yes No Please make a selection.
If yes, what language(s)?
Special skills or talents you offer as a volunteer?
Community Affiliations:
Physical limitations to be considered in placing you in a volunteer assignment?	Required
Why would you like to volunteer?	A value is required.Required

Time Preferences

Select days preferred: Monday Tuesday Wednesday Thursday Friday Minimum number of selections not met.Maximum number of selections exceeded.Minimum number of selections not met.

Select times preferred: Mornings Afternoons Evenings Minimum number of selections not met.Maximum number of selections exceeded.Minimum number of selections not met.

Areas of Interest

Select areas of interest:

Reception/Visitor Contact
English as a Second Language Tutor
Clothing Room
GED Classes for Adults
Children's Afterschool Tutoring
Children's Summer Enrichment Program
Fundraising Events Minimum number of selections not met.Maximum number of selections exceeded.Minimum number of selections not met.

Emergency Contact Information

Person to notify in case of emergency
Name:	A value is required.Required
Address:	A value is required.Required
City:	A value is required.Required
State:	Please select an item.Please select an item.
Zip:	A value is required.RequiredInvalid format.
Phone:	A value is required.Invalid format.RequiredInvalid format.
Alternate Phone:	RequiredInvalid format.

Physician Contact for Applicant
Doctor's name:	A value is required.Required
Phone:	A value is required.Invalid format.RequiredInvalid format.

Volunteer Release Agreement

As an unpaid volunteer, I hereby release and hold harmless Our Lady of Mercy Community Outreach Services, Inc. from any and all liability for any and all damages or injuries that may result to myself or my property as a result of assisting Our Lady of Mercy Community Outreach Services, Inc., to carry out its charitable purposes.

Please make a selection.I Agree. I have read to the Release, which has been explained to my satisfaction, and I hereby knowingly, voluntarily and free of any coercion or duress by anyone, sign the Release.

Please make a selection.I Agree. Believing that Our Lady of Mercy Outreach Services, Inc. has a real need of my services as a volunteer worker who serves without pay, I will uphold the tradition and standards of Our Lady of Mercy Services.

Signature:	A value is required.RequiredMinimum number of characters not met.
Date:	A value is required.Invalid format.RequiredInvalid format.

Download a printable application