• Catholic Community Services of Lane County
    1025 G Street | Springfield, OR 97477
    541-345-3628  |  www.ccslc.org

  • Volunteer Application

  • Format: (000) 000-0000.
  • Date of Birth
     / /
    2 digit month, 2 digit day, 4 digit year
  • Is this application for a JOBS PLUS/DHS Work Experience program?*
  • Is this application for a court-ordered community service?*
  • Are you under 18 years of age?*
  • Availability

    (check all that apply)
  • Please Note: Most volunteer opportunities are during regular business hours, Monday through Friday.

  • Preferred Days
  • Preferred Hours
  • Location
  • I would like to volunteer      hours per week.

  • Emergency Contact

  • Format: (000) 000-0000.
  • By signing my name below, I acknowledge that I am volunteering for Catholic Community Services of Lane County, Inc. (CCS). I agree to absolve and hold harmless CCS from and against any blame and liability for any injury, misadventure, harm, loss, inconvenience, or damage hereby suffered or sustained resulting from participation as a volunteer for CCS. I understand that information provided by clients and the content of discussions or other communications regarding clients and client information by CCS personnel are confidential and privileged. I understand that said information may not be divulged to any person outside of CCS without a court order. I promise not to divulge or otherwise make public such information whether obtained from clients or from CCS personnel. I give permission to use any photograph, video recording or audio recording of myself, obtained during volunteer activities, in CCS informational material and for CCS publicity, training and promotional purposes and without compensation from CCS. I read and understand the above.

    I certify that the information provided is accurate and understand that my electronic signature below is my legal and binding signature.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: