PRRC Volunteer Interest Form

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 will follow up with you soon!

Name and address

First name:

Last name:

Title:

Type:

Street 1:

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:

High school:

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:

Volunteer Orientation Sign Up

Ready to sign up for a Volunteer Orientation? Complete the form at this link to sign up for an orientation. https://goo.gl/qnp3T3

NOTE: Please bring a cleared TB test to the orientation. Thank you!