VOLUNTEER APPLICATION

Volunteer Applicant

Applicant's Name:

 Please enter your name.Please enter your name (100 character limit)
Address: Please enter your address.Please enter your address.Please enter your address.
City: RequiredPlease enter your city.Please enter your city.
State Please select your state.
Zip Please enter your zipcode.Please enter your 5 digit zipcode.
Phone: A phone number is required.Please enter your phone number.
Email Address: Please enter your email address.Please enter a valid email address.Please enter a valid email address.Please enter a valid email address.
Alternate Phone: Please enter a phone number with area code.
Are you currently employed?
If yes, where?
Work Phone: Invalid format.
Have you ever worked as a volunteer before?
If yes, where?
Are you fluent in any language other than English?
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?
Why would you like to volunteer? RequiredExceeded maximum Minimum not met.
   

Time Preferences
   
Check days preferred:  
Check times preferred:  

 

Areas of Interest
   
Check areas of interest:  
 
 
 
 
 
 

Emergency Contact Information
Person to notify in case of emergency
Name: A value is required.
Address: A value is required.
City: A value is required.
State: Please select a valid item. Please select state.
Zip: Invalid format.Required
Phone: Invalid format.Required
Alternate Phone: Invalid format.Required
   
Physician Contact for Applicant
Doctor's name: Required
Phone: Invalid format.Required
   

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 have read to foregoing 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. 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 the Outreach Services.

Signature: Please enter your full name.
  Date: Please enter today's datePlease enter a valid date.Please enter today's date.

pdf file ico download a printable application