Volunteer Application Form

I am:

New Volunteer

Returning Volunteer

Today's Date

First Name (or Group Leader Name)

Last Name

For Groups, Please List Additional Group Members:

Address

City

State

Zip

Mobile Number

Additional Phone Number

Email Address

Receive Center Emails?

Yes

No

Birthdate

CPA City/Location Preference:

Highland Heights

Lyndhurst

Mayfield Heights

Mayfield Village

Richmond Heights

South Euclid

No Preference

Main Office at South Euclid Community Center

Emergency Contact:

Emergency Phone Number

Preferred Method of Communication (check all that apply)

Phone

Text

Email

Available Volunteer Days (keep in mind that weekend opportunities are limited by type)

Hours of Availability:

Morning (9:00AM - 12:00PM)

Afternoon (12:00PM - 5:00PM)

Evenings

Amount of Hours Available to Volunteer

Additional Information, if applicable:

What Volunteer Opportunities Interest You?

If Other, Please Specify

Volunteer Hours Verification Needed

My Employer Matches Volunteer Hours

I'm Interested in Volunteering for School Credit

Employer or School Name (if applicable)

Employer or School Address:

Heavy Lifting (30lbs or more) is OK

I prefer:

Sitting

Standing

No Preference/Sitting/Standing are OK

Do you have any special accomodations or needs?

I agree to be photographed, videotaped, and/or recorded while volunteering, and understand that this media may be used in Community Partnership on Aging Marketing

I accept

Consent and Waiver: I affirm that the information provided on this form is true and correct. I authorize the Community Partnership on Aging to verify this information. I understand that a criminal background check may be requested for certain volunteer opportunities. I have read and understand the various volunteer roles and am able to perform those roles in which I’ve applied. I am volunteering my time for personal reasons and understand that I will not be paid for my services as a volunteer and I expect no compensation. Furthermore, I understand that this application will help in determining the best fit of my skills for the Community Partnership on Aging. By participating in this volunteer activity, I acknowledge and agree to the following terms on behalf of myself and/or my group: 1. Voluntary Participation: I understand that participation in this activity is completely voluntary. 2. Assumption of Risk: I recognize that volunteering may involve certain risks, including but not limited to personal injury, property damage, or illness. I voluntarily assume all such risks related to participation. 3. Release of Liability: To the fullest extent permitted by law, I release and hold harmless Community Partnership on Aging, its officers, employees, agents, and affiliates from any and all claims, liabilities, or damages arising from or related to participation in this volunteer activity. 4. Medical Treatment: I authorize Community Partnership on Aging to provide or arrange for emergency medical care if necessary, and agree to be responsible for any costs incurred. 5. Compliance: I agree to follow all safety instructions and rules provided by Community Partnership on Aging staff or representatives.

I accept

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