St. Patrick Center - Volunteers

Thanks for offering to volunteer!
Please complete the following information and
click on "Submit" at the bottom of the page.

First Name
Last Name
Organization Name
Mailing Address
Address
City
State
Zip Code
Primary Phone	(ie 555-555-5555)
Secondary Phone	(ie 555-555-5555)
Date of Birth	(Must be at least 16)
E-mail

Please note:
We cannot guarantee that a volunteer position will be available at the time we receive your application. We will contact you should interests, availability, and skills match current opportunities.

Some volunteer positions require a background check and taking a class called Protecting God's Children.

AVAILABILITY: Please fill in the times that you are available on each day.

Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday

When are you available to begin volunteering?

Are you interested in volunteering on a recurring basis?

Are you interested in volunteering only on an "on call" and
event only basis?

Are you applying for volunteer opportunities to fulfill school
or church service hours?

If you are volunteering for service hours, how many hours do you need to complete?
By when?

Previous volunteer experience:

How did you learn about St. Patrick Center?

Why do you want to volunteer?

Is there anything else that you would like for St. Patrick Center to know about you?

SKILLS AND INTEREST: Please check all applicable boxes.
This does not guarantee we have a position available
Administrative:
Microsoft Word Microsoft Excel Microsoft Power Point
Microsoft Outlook Microsoft Publisher
Data Entry Phones Filing Graphic Design
Child Care:
Early Child Hood Education Story Time & Activities General Child Care
Social Work:
Social Worker Counselor Therapist
Education:
Teacher Tutor Project REACH Mentor
Industrial:
Painting Maintenance Landscaping
Healthcare:
Doctor Nurse Dentist Chiropractic
ADJECTIVES ABOUT YOU: Please check all applicable boxes.
Creative Ambitious Athletic Active Organized Artistic
Quiet Independent Talkative Outgoing Affectionate
Social Crafty Academic Humorous

EMERGENCY CONTACT INFORMATION:

Name:
Relationship:
Primary Phone:
Secondary Phone:
Primary Physician and Preferred Hospital:
Medical Conditions:

REFERENCES:

Name
Phone
E-mail
Relationship

Name
Phone
E-mail
Relationship

I understand and agree that in the performance of my duties as a volunteer at St. Patrick Center I must hold in the strictest confidence any observations I may make or hear regarding clients, client families or staff. I acknowledge that all statements made in the application are true, complete and correct. I hereby release, indemnify and hold harmless St. Patrick Center, the organizers, sponsors and supervisors of all activities from any and all liability in connection with any injury (including any injury caused by negligence). I likewise hold harmless from liability any person transporting me to or from any St. Patrick Center facility or activity. In addition, St. Patrick Center has permission to utilize any photograph or video taken of me for publicity purposes.
Submit