Individual Volunteer Form

If you need your hours tracked and letter of proof for (school, court, etc.) DO NOT SUBMIT A VOLUNTEER FORM. You must enroll into our Community Service (CS) Program instead, prior to serving hours. Please call (209) 467-0703 for CS Program details.

Form Instructions FORMS ARE TO BE SUBMITTED BY ADULTS OR CHAPERONES ONLY. (If you are under the age of 18, please do not submit a volunteer form)
First Name *
Last Name *
Preferred Name (If any, other than first name)
Cell Phone Number *
Home Phone Number
Email (you may be contacted at this email)
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Current Employer If you are interested in volunteering for our Medical or Dental clinic, please state your certified occupation.
City
Zip Code
Do you need your hours tracked and verified for your records or any other reasons?
NO (I do not need my hours tracked. I understand that my hours will not be verified later.)YES (I must enroll into a different program: the Community Service Program instead, or else my hours will not be tracked or verified)
Are you 18 years of age or older? *
If you are under the age of 18, an adult chaperone must complete this volunteer form.YesNo
Are you submitting a form as chaperone for a youth volunteer? *
Yes, I am a chaperoneNo, I am not a chaperone
If yes, what is the first and last name of the youth/minor you will be chaperoning?
Are you volunteering as part of a group? *
If yes, please have your group leader submit a single GROUP FORM instead.YesNo
Have you ever been convicted of a felony? *
YesNo
If yes, please explain and include dates:
Note: The fact you have been convicted of a felony does not dismiss you automatically from volunteering with St. Mary’s Dining Room. We consider all applications that we receive.
What languages do you speak?
What volunteer opportunities are you interested in? *
Volunteers are welcome to join us in our Kitchen and Dining Room. We can always use a helping hand! For other departments, we may require additional paperwork, certifications and/or a screening process.Kitchen (16 years & older are welcome with their adult chaperone)Dining RoomSocial Services (Screening Process Required)Men's Clothing & Hygiene CenterWomen's & Children's Clothing & Hygiene CenterMedical Clinic / Dental Clinic (Certifications Required)Facilities - Campus MaintenanceOther

When are you available to volunteer? (Please mark all that apply)

Sunday
07:30 am ‐ 9:30 am9:00 am - 11:00 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
Monday
07:30 am ‐ 9:30 am9:00 am - 11:00 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
Tuesday
07:30 am ‐ 9:30 am9:00 am - 11:00 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
Wednesday
07:30 am ‐ 9:30 am9:00 am - 11:00 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
Thursday
07:30 am ‐ 9:30 am9:00 am - 11:00 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
Friday
07:30 am ‐ 9:30 am9:00 am - 11:00 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
Saturday
07:30 am ‐ 9:30 am9:00 am - 11:00 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
When would you like to start volunteering? (Excluding Thanksgiving and Christmas Day) We do not schedule volunteer opportunities on Thanksgiving or Christmas Day. We can always welcome the help of volunteers before and/or after the holidays.

In Case of Emergency Contact:

Name *
Phone Number *
Date *
VOLUNTEER GUIDELINES Out of respect and privacy for our clients, we do not permit any forms of video, photography, evangelization and/or interviews with our clients on our campus.

• 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. Please ask for further details.
• Dress appropriately for each volunteer shift. Long pants (no shorts or capris). Sleeved shirt (T‐shirts are good. no tank‐tops). Closed toed shoes (no sandals or high heels). Aprons, hairnets and gloves will be provided. You are welcome to bring your own or wear a hat in place of a hairnet.
• Keep personal belongings to a minimum. St. Mary’s Dining Room is not responsible for lost or stolen items.
• Follow all staff instructions, safety procedures, and tasks assigned. Inform staff immediately if you are not comfortable with an assigned task.
• 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.
• Volunteers have the right to work in an environment free from harassment. This includes unwelcome verbal and/or physical conduct that degrades or shows hostility or aversion toward a staff member, another volunteer, or a client. Please inform your supervisor if any problems should arise.

We trust that your volunteer experience will be a positive one.
First Name *
Last Name *
I have read and understand the above volunteer guidelines. By selecting "yes" below I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information may result in my release. *
YesNo
Date *
Please allow up to 2 weeks to receive a phone call or email response from our Volunteer Coordinator. We look forward to welcoming you on our campus!

Verification

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