OUTREACH VOLUNTEER APPLICATION

This application is for those wishing to volunteer locally at our Outreach Center. If you are interested in our Special Volunteer programs lasting from 2 weeks to 9 months with housing provided in our Volunteer Housing Unit (The Carpenter's House) complete our Ministry Volunteer Application.

Volunteer Applicant

Applicant's Name:

 A value is required.
Address: A value is required.
City: A value is required.
State
Zip A value is required.Invalid format.
Phone: A value is required.Invalid format.
Email Address: A value is required.Invalid format.
Alternate Phone:
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?
   

Time Preferences
   
Select days preferred:  
Select times preferred:  

 

Areas of Interest
Select areas of interest:  
 

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

 

pdf file ico download a printable application