Group Leader Information

First name:

Last name:

Street:

City:

State:

* Zip: *

Primary phone:

Secondary phone:

Email address:

Date of birth:

(year optional)

Group Specifics

Group or Program Provider name:

Number of Members:

Type/Mission (Scouts, Glee Club, Youth Group, Retail Business, etc.)

References

Please list the names and contact information for two references who are NOT relatives or family members.

1

2

First name:

Last name:

Primary phone:

Email address:

Reference Relationship:

Vincentian Facilities (Choose preferred locaton)

Location(s) you would like to volunteer:

Vincentian Charitable Foundation

Vincentian Collaborative System (8250 Babcock Blvd., Pgh, PA 15237)

Vincentian de Marillac (5300 Stanton Ave., Pgh, PA 15206)

Vincentian Home (111 Perrymont Rd., Pgh, PA 15237)

Vincentian Home Personal Care (111 Perrymont Rd, Pgh, PA, 15237)

Vincentian Marian Manor (2695 Winchester Drive, Pgh, PA 15220)

Vincentian Schenley Gardens (3890 Bigelow Blvd., Pgh, PA 15213)

How did you hear about us?

(Website, staff member, online posting, radio/tv ad, church bulletin, etc.)

I Agree

As a Vincentian volunteers, we agree to:

-Uphold the values of spirituality, compassion, dignity, quality, stewardship, advocacy, collaboration, and innovation.

-Commit to the Vincentian mission to nurture and sustain a ministry of compassionate care.

-Promote and support an environment that treats others with kindness, respect and dignity.

-Maintain high standards of confidentiality.

-Ensure resident/client health and safety by complying with safety guidelines and program standards.

-Be prompt and dependable.

-Demonstrate good decision-making skills.

-Complete required training and development programs.

-Accept supervision, instruction and feedback in a positive manner.

-Complete an interview and screening processes to ensure the safety and well-being of our residents/clients.

I understand that in connection with my volunteer application, referencing and background checks will be conducted to assess our Group/Organization's ability to serve the mission of Vincentian. On behalf of our Group/Organization, I freely give my consent for Vincentian to do so. If we have members under 18 years of age, I understand that we are responsible to have parent/guardian permission to participate, emergency contact information, and parent/guardian agrees to the terms of referencing.

Please check "I Agree" below if you agree to these conditions.

I Agree