Please complete this application if you are interested in becoming a Family Caregivers Center of Mercy Volunteer. Once you complete the form, click the Continue button at the bottom.

Contact Information

Please complete the following information regarding your general contact information. If you do not have an email address, please use

Skills and Interests

The following information helps us get to know you better before meeting face-to-face. Please complete as much as possible.


Please indicate the days and times you are usually available to volunteer.

Cargiving Experience

Knowledge of Dementia

Anything Else?

I Agree

I understand and agree that submitting this application form does not automatically register me as a Family Caregivers Center of Mercy Volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

I understand and am aware that a criminal background and dependent adult abuse check will be completed prior to being accepted as a Family Caregivers Center of Mercy Volunteer.

By submitting this form, I attest that the information I have provided on the form is true and accurate. I understand and agree that falsification of this or any other information is grounds for immediate termination.