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):

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 like information about joining the Heritage Christian Professionals?

Yes
No

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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