Teen Volunteer

Personal Information

Teen Volunteer Application
Name*

First NameLast Name
Preferred name*
Street Address*
City*
State*
Zip Code*
Phone Number*
Email*
Colleen Holcomb, Volunteer Services Manager, will reach out to you to set up a meeting. How do you prefer to be contacted?*

PhoneEmail
Work Permit ID #
Date of Birth*
Date of Birth*

MonthDayYear
Date
Do you have a prior connection to St. Ann's?*

YesNo
If yes, how have you been connected?
Personal Reference
Name*

First NameLast Name
Relationship*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
(XXX) XXX-XXXX
Email*
example@example.com
Parent or Guardian
Parent or Guardian: Full Name*
Relationship*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
Emergency Contact Information
Emergency Contact Full Name*

First NameLast Name
Relationship*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
Location to volunteer at

Select all that apply
Location*

Irondequoit CampusWebster Campus (Cherry Ridge)Durand Adult Day ServicesPortland Home Connection (Adult Day)Wherever I'm needed most
Availability & Hours

NOTE: *All volunteers must complete a minimum of 20 volunteer hours over a flexible time period*
I confirm I can volunteer for a minimum of 20 hours*

YESNO
What days of the week are you able to volunteer? (Select all that apply)*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
NOTE: Volunteers under the age of 18 may require parent or guardian supervision during weekend volunteering.
What time of day are you able to volunteer?*

MorningsAfternoonsEvenings
Are these required service hours?*

YesNo
If yes, how many hours are needed?
When do you need complete these hours by?
What are the hours for?
Education
High school*
School Organizations, Clubs, Groups or Part-time jobs*
Skills, hobbies, and special interests*
Previous work as a volunteer*
Signatures

By entering name and date below, you are verifying that all information entered above is true and accurate
Volunteer Signature*
Today's Date*

MonthDayYear
Date
Parents/Guardians

By entering name and date below, you are verifying that all information entered above is true and accurate
Parent/Guardiant Signature*
Date*

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Personal Information

Personal Reference

Parent or Guardian

Emergency Contact Information

Location to volunteer at

Availability & Hours

Education

Signatures

Parents/Guardians