Individual Volunteer Form

NOTE: If you need your hours tracked and/or verified 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 ONLY BY ADULTS OR CHAPERONES. IF YOU ARE UNDER THE AGE OF 18, PLEASE DO NOT SUBMIT A VOLUNTEER FORM. THANK YOU.
First Name *
Last Name *
Preferred Name (If any)
Cell Phone Number *
Home Phone Number
Email
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Current Employer
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 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, and you are the Group Leader, please submit a single GROUP FORM instead. If you are not the group leader, please contact your group leader to see if they have already submitted a group form.YesNo
Have you ever been convicted of a felony? *
YesNo
If yes, please explain and include dates:
Please 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 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 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
Monday
07:30 am ‐ 9:30 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
Tuesday
07:30 am ‐ 9:30 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
Wednesday
07:30 am ‐ 9:30 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
Thursday
07:30 am ‐ 9:30 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
Friday
07:30 am ‐ 9:30 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
Saturday
07:30 am ‐ 9:30 am11:00 am ‐ 1:00 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:00 pm
When would you like to start volunteering?

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

Please enter any two digits *Example: 87
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