Please fill out the following application.

What's your email address?

Your information


Required fields are marked with an asterisk (*).
First Name *
Middle Inital *
Last Name *
Address *
City *
State *
Zip Code
Home Phone Number
Cell Phone Number

For example, 123-456-7890
Birth Date *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
Place of Employment
Emergency Contact: In the event of an accident or illness while serving at Shorehaven, the person listed will be called if necessary. Please provide a first and last name, address and phone number(s). *
Why are you interested in volunteering at Shorehaven? If you are a student needing service hours how many hours do you need?
References: Please provide two references we may contact. First and last name, phone number, and relationship to you. *
What areas are you interested in volunteering? Note: when you see the description escorting residents, it means you will be pushing residents in wheelchairs to their appointments.residents




















How often would you be available?


Which days(s) would you prefer to volunteer?






Hours vary on the type of volunteer work you choose to do. What time frames work best for you?



Have you ever been convicted of a felony, misdemeanor, or ordinance violation other than a traffic violation? If yes, please explain in the box below.

Waiver

I certify that the information in this application is correct to the best of my knowledge. I authorize Shorehaven to check the references I provided and check with the appropriate public authorities regarding my background. I understand that should I be offered a volunteer position, any misrepresentation by me may lead to termination. I also understand that my volunteer service can be terminated, with or without cause and/or notice, at any time. I understand that completing the application process does not guarantee acceptance as a volunteer.
I authorize Shorehaven to publish my name, picture, testimonials and/or survey results in marketing materials which promote the organization and its programs. This includes but is not limited to: video, advertising, publications, website, annual reports, committee reports and social media. I understand no compensation will be paid to me. I understand that Shorehaven will be held harmless for any unauthorized reproduction of information by parties not authorized by the organization.