Individual Volunteer Form

Do you need to complete hours for: Court, School, Church, etc.? You MUST enroll into our Community Service Program in the Administration Office. Do not submit a Volunteer Form if you need your hours verified & signed. Contact Secilia at 209.467.0703

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 FORM)
Are you volunteering as part of a group? *
If yes, please have the group leader must submit a single GROUP FORM instead.YesNo
First Name *
Last Name *
Preferred Name: If any, other than your first name.
Phone Number *
Email (You may be contacted by Email to schedule volunteer opportunities) *
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Current Employer and Occupation (optional)
City
Zip Code
What languages do you speak?
DO YOU NEED YOUR HOURS TRACKED AND VERIFIED WITH A LETTER OF PROOF?
If YES, you must register into a different program called: Community Service Program, or else your hours will not be verified.NO, I do not need my hours tracked. I understand that any hours served in the Volunteer Program are NOT tracked and will NOT be verified at any later date.
Are you 18 years of age or older? *
If you are a minor, please do not submit a form for yourself.YesNo
Are you submitting a form as chaperone for a minor (under age 18)? *
Chaperones must be actively supervising and volunteering alongside the minor participant at all times on our campus.Yes, I am a chaperoneNo, I am not a chaperone
If yes, what is the Name and Age of the minor(s) you will be chaperoning?

Volunteerism

What volunteer opportunities are you interested in? *
Volunteers are welcome to join us in our Kitchen and Dining Room. We serve 3 hot meals, 7 days a week! 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 with adult chaperones.DINING ROOM: All ages welcome with adult chaperones.MENS CLOTHING & HYGIENE CENTER (Monday - Friday) 7:30am - 2:30pmWOMEN & CHILDRENS HYGIENE CENTER (Monday - Friday) 7:30am - 3:00pmCLIENT ENRICHMENT SENIOR CENTER: Screening Required. (Tuesday - Thursday) 12:30pm - 4pmSOCIAL SERVICES: Screening Required & Weekly Time Commitment (Monday - Friday)MEDICAL CLINIC: Medical Certifications Required! (Monday - Friday)DENTAL CLINIC: Dental Certifications Required! (Monday - Friday)LAUNDRY ROOM (Monday - Friday) 7:30am - 2:00pmFACILITIES MAINTENANCE (Monday - Friday) 8:00am - 4:00pmBARBER SERVICES (Tuesday- Friday) 8:00am - 11:00am
Which days would you like to volunteer? *
On the Weekdays (Monday - Friday)On the Weekends (Saturday - Sunday)Both

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

Sunday (Kitchen & Dining Room)
07:30 am ‐ 9:30 am11:45 am ‐ 1:15 pm4:30 pm ‐ 6:30 pm
Monday
07:30 am ‐ 9:30 am11:00 am ‐ 1:15 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:30 pm (for Dinner Service Only)
Tuesday
07:30 am ‐ 9:30 am11:00 am ‐ 1:15 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:30 pm (for Dinner Service Only)
Wednesday
07:30 am ‐ 9:30 am11:00 am ‐ 1:15 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:30 pm (for Dinner Service Only)
Thursday
07:30 am ‐ 9:30 am11:00 am ‐ 1:15 pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:30 pm (for Dinner Service Only)
Friday
07:30 am ‐ 9:30 am11:00 am ‐ 1:15pm1:00 pm ‐ 3:00 pm4:30 pm ‐ 6:30 pm (for Dinner Service Only)
Saturday (Kitchen & Dining Room)
07:30 am ‐ 9:30 am11:45 am ‐ 1:15 pm4:30 pm ‐ 6:30 pm
What DATE or MONTH 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 use the help of volunteers before and/or after the holidays!

In Case of Emergency Contact

Name *
Phone Number *
DRESS CODE & PERSONAL BELONGINGS -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. Please do not bring any personal belongings. We do not have a secure storage area and can not be responsible for lost/stolen items.
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.
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. Please call 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.

Volunteers have the right to work in an environment free from harassment. Please inform a member of staff if any problems should arise.
PHOTO/MEDIA RELEASE My signature below acknowledges my understanding that I 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 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.
I have read and understand the above volunteer guidelines. I understand that if I do not comply with these guidelines I will be asked to leave. *
YesNo
First Name *
Last Name *
Date *
Please allow up to 10 days 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 numerical digits below.Example: 25
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