Volunteer Application Form Home > Learn About Volunteering > Volunteer Application Form A A A Submit form for individual volunteering or group participation. "*" indicates required fields PhoneThis field is for validation purposes and should be left unchanged.This application is on behalf of:* An individual or family A corporation or group like Scouts CONTACT INFORMATION: INDIVIDUALName First Last Date of birth*Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail CONTACT INFO: GROUPS OR CORPORATIONSName of Group or OrganizationAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail FOR INDIVIDUALSDo you have any volunteer experience?* Yes No If yes, please explain:TransportationDo you have reliable transportation? Yes No Do you have a valid driver’s license? Yes No Background ChecksHave 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 NamePhone NumberEmail Address Add RemoveUse + sign to add information for multiple references.PREFERENCESFOR 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 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): Add RemoveUse + sign to add names to list.Are allergies a concern? Yes No If yes, please explain:ADDITIONAL INFORMATIONWhat 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. Yes No By submitting this form I certify that I am the primary contact and that all information is correct.
