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.

Parents and group leaders of high school students: This application form is to be filled out by the students themselves and all coordination will be directly with them, the volunteers. Parents and group leaders are more than welcome to join the information session to learn more about the program and what we do.

Next orientations: June 2023 and September 2023

We will respond to your application in the month leading up to our orientation 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

(Required) 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?*

School/Program Affiliation

If you are reaching out to us to gain service hours for a school/program, what is the name of your school/program? What is the number of hours you are required to provide and what is the timeframe for completion?

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 40 hours.

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

I Agree