Please complete this application form if you are interested in becoming a Pine Rest Christian Mental Health Services volunteer. Once you complete the form, click the Continue button at the bottom.

Name and address


Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.


Criminal History

Have you ever been convicted of a felony or misdemeanor? If yes please provide details on each conviction including dates.


Emergency Contact

Please provide us with the name and contact information for a family member or friend who we are able to contact in the event of an emergency.


Volunteer Interest

Please briefly explain why you are interested in volunteering at Pine Rest.


Availability

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


References

Please provide three references who can speak to your commitment and dedication as a potential volunteer. Please do not select family members.

References are required for all volunteer areas except the Rustic Market. Failure to provide references may delay the processing of your application.


The information contained in this application is true. I understand and agree that any misrepresentation or false statement by me in connection with the application will constitute sufficient cause for Pine Rest to terminate my volunteer service.

I understand and agree that all information furnished in this application may be verified by Pine Rest, I hereby authorize all individuals and organizations named or referred to in this application and any law enforcement organization to give Pine Rest all information relating to such verifications and hereby release such individuals, organizations and Pine Rest from any and all liability from any claims or damages resulting there from.