Thank you for your interest in volunteering at the Pomeroy Center. We are delighted to welcome volunteers high school age and older. Please complete this form and click the submit button at the bottom. We accept applications on a rolling basis, and will follow up during the next application review period.

Name and Address

First name:

Last name:

Title:

Nickname:

Type:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

* OK to call me here

Email address:

Date of birth:

Preferred Pronouns:

High school:

College:

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.

Emergency Contact

First name:

Last name:

Home phone:

* OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Email address:

Relationship:

Skills and Interests

Why are you interested in becoming a volunteer at Pomeroy at this time? What skills do you possess that will add value for our programs and the participants?

Volunteer Agreement Section

I understand and agree that submitting this application form does not automatically register me as a Pomeroy Recreation & Rehabilitation Center 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 also understand that the minimum service commitment for my first year of service is 25 hours.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I Agree