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Volunteer Application

Contact Information


*


(mm/dd/yyyy)


Skills and Interests:







Availability


Personal Data

**We will need a copy of a government issued ID (such as a driver's license).

If you have a digital copy of your government issued ID, you may upload it here.


References

List the names, addresses, phone numbers, and email addresses (if applicable) of three personal references, other than relatives:



Client Confidentiality/Protection Pledge/Emergency Treatment

Please read the following statement carefully:

Maintaining the confidentiality of the residents of Providence House and their families is of the utmost importance. As a volunteer, you will be expected to abide by this organization's policy to protect the confidentiality of those who live here. In agreement with this policy, I pledge to honor the privacy and uphold the confidentiality of each resident/child at Providence House. Providence House reserves the right to obtain a criminal background and social security number check. If I should become ill/injured, I authorize Providence House to arrange emergency treatment and I accept responsibility for payment of medical services rendered. 


Please type your name as your digital signature.