Individual Volunteer Application

Do you need to complete service hours for: court, school, church, etc.? If so, you MUST enroll into our Community Service (CS) Program in our Admin Office. Volunteer hours are not tracked. Do not submit a Volunteer Form if you need your hours signed off.

  • Volunteerism

  • We are seeking the support of medical/dental professional volunteers. At this time we cannot offer experiential learning and/or shadowing opportunities for students or uncertified individuals at our clinics.
  • When are you available to volunteer? (Please mark all that apply)

  • In Case of Emergency Contact

  • -Long pants (no legs showing). -Sleeved shirt (T‐shirts are OK. (no tank‐tops).
    -Closed toed shoes (tennis shoes are ok, no sandals or high heels).
    -Aprons, hairnets and gloves will be provided. A baseball cap can be worn in place of our hairnets.
    Please do not bring any personal belongings (purses, backpacks, etc)
    We do not have a secure storage area and can not be responsible for lost/stolen items.
  • Out of respect and privacy for our guests, we do not permit any forms of video, photography, evangelization and/or interviews with our guests on our campus.

    COMMUNITY SERVICE PROGRAM If you need to track your hours for any reason (court, school, service clubs, etc.), you will need to register for our Community Service Program prior to serving hours. Please call Secilia at 209.467.0703 for details.
    PROCEDURES Follow all staff instructions, safety procedures, and tasks assigned. Inform staff immediately if you are not comfortable with an assigned task.
    YOUTH & CHAPERONE POLICY Volunteers under 18 years of age (youth) must have an adult chaperone. One adult may chaperone up to 5 youth. • Volunteers must be a minimum of 16 years of age to volunteer in the kitchen area. Youth under the age of 16 are welcome to volunteer in our dining room. • Chaperones MUST be actively supervising and volunteering alongside the minor(s) throughout the entire volunteer experience.
    Do not remove and/or consume any property or donations from St. Mary's Dining Room without the permission from SMDR staff.

    Please inform a member of staff if any problems should arise.
  • My signature below acknowledges my understanding that I and/or my party, may be photographed or captured in video recordings during my volunteer experience. I hereby authorize St. Mary’s Dining Room to publish any photography/video taken of me/my party for use in St. Mary’s Dining Room’s publications or other media material produced including, but not limited to: brochures, television, websites, social media and/or other marketing materials. It is understood that my participation in any publication, websites, or other media produced by St. Mary’s Dining Room, and/or an entity acting with their permission, confers upon me no rights of compensation or ownership whatsoever.