Volunteer Application Name * First Name Last Name Month/Year of Birth Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Prior Volunteer Experience: Any skills or certifications that may be applicable: (First Aid, CPR, other) Local Reference #1: Name and Contact Info (phone or email) * Local Reference #2: Name and Contact Info (phone or email) * Do you have access to the internet to support participation in our digital volunteer signup system? Yes No Do you have any medical concerns that may interfere with your ability to interact with the guests or perform your duties at the Shelter? Yes No I consent for the Samaritan Group Board of Directors to run a Maryland Judiciary Case records search on me. * Yes No Signature of Applicant * I have read, or will read, the Volunteer instructional packet to understand the procedures and rules of the Shelter and my responsibilities to the guests and the host location. I will do my best to represent the community to those that are served and abide by all of the rules of the shelter. Date * MM DD YYYY Thank you! We have received your volunteer application and we will be in touch with you shortly with more information.
