Volunteer Application Form | Heritage Christian Services

This application is on behalf of:*

An individual or family
A corporation or group like Scouts

CONTACT INFORMATION: INDIVIDUAL

Name

First Last

Date of birth*

Address

Street Address Address Line 2 City State ZIP Code

Phone

Email

CONTACT INFO: GROUPS OR CORPORATIONS

Name of Group or Organization

Address

Street Address Address Line 2 City State ZIP Code

Phone

Email

FOR INDIVIDUALS

Do you have any volunteer experience?*

Yes
No

If yes, please explain:

Transportation

Do you have reliable transportation?

Yes
No

Do you have a valid driver’s license?

Yes
No

Background Checks

Have you ever been convicted of a crime?

Yes
No

If yes, state what type of crime, the court and date of conviction and present status.

Do you have a conviction or prior history of child abuse, neglect or mistreatment?

Yes
No

What special interests or hobbies can you share (e.g., fishing, quilting, music, arts, etc.)?

Describe any experience you may have with people who have developmental disabilities.

Please list three references and their contact information.

Reference Name	Phone Number	Email Address

Use + sign to add information for multiple references.

PREFERENCES

FOR CORPORATIONS/GROUPS: Have you ever volunteered for Heritage Christian?*

Yes
No

If yes, please explain:

I/we want to volunteer in areas closer to:*

Rochester
Buffalo

Areas of Interest (check all that apply):

Internships or field work
Respite - spending time with children and adults who enjoy our short-term care services and homes
Special events - community events that promote the good work and goodwill of Heritage Christian Services
International Ministries – wheelchair collections plus home builds and serving at retreat centers in Central America
A Second Thought Resale Shop –thrift store in E. Rochester only
Springdale Farm –public demonstration farm in Ogden only
Heritage Christian Stables –therapeutic riding program in Webster only (Minimum volunteer age of 14)
Club Adventure - respite program in Tonawanda only
Community garden in N. Tonawanda only

List dates and timeframes that you wish to volunteer:

Number of people we can expect (age 18 or over):

Number of youths (under age 18):

Names of Youth we can expect (under age 18):

Use + sign to add names to list.

Are allergies a concern?

Yes
No

If yes, please explain:

ADDITIONAL INFORMATION

What led you to choose Heritage Christian Services?

Would you be interested in sponsoring Heritage Christian Services, especially events that include perks, like at the Golf Classic and Heritage Hero Run + Stroll + Roll?

Yes
No

By submitting this form I certify that I am the primary contact and that all information is correct.

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Phone

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